Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

Oral Answers to Questions — ENVIRONMENT

National Parks

Mr. Andrew F. Bennett: To ask the Secretary of State for the Environment if he will make a statement about funding for measures to combat footpath erosion in national parks.

The Minister for the Environment and Countryside (Mr. David Trippier): Seventy-five per cent. of national parks approved expenditure is met by the Government through national parks supplementary grant. Aggregate NPSG is based on bids for resources made by each national park for identified national and local priorities, including counter-erosion work and rights of way. Aggregate NPSG for 1990–91 is £9.97 million, an increase of almost 10 per cent. over 1989–90 figures, and over 20 per cent. in real terms since the Government took office in 1979.

Mr. Bennett: I thank the Minister for that reply, but I am sure that he is well aware of the growing problems of footpath erosion in the Yorkshire dales on mountains such as Whernside, Pen-y-ghent and Ingleborough, in north Wales on Tryfar, and in the Lake District. Will he ensure that there are sufficient funds to protect footpaths from erosion and that we open up far larger areas of the countryside so that the wear and tear can be spread over a greater area, not concentrated on one or two honey spots which people visit at present?

Mr. Trippier: I am sympathetic to the hon. Gentleman's point. There has been adequate funding in this year's public expenditure survey round. Given sufficient funding in the forthcoming PES round, we hope to be able to accommodate maintenance in the districts to which he referred.

Mr. Harry Greenway: Will my hon. Friend take cognisance of the fact that in some national parks, footpaths are also used by horse riders and some walkers complain that footpaths get cut up? Will he ensure that there is always money to maintain the paths that horses also use and remind walkers that if it is muddy, they need to wear gumboots?

Mr. Trippier: I am happy to echo the commercial that my hon. Friend has made to the House and confirm—I have a personal interest in the matter—that I consider bridleways to be as important as footpaths.

Ms. Walley: Does not the Minister realise that there is insufficient money to protect footpaths from erosion? Is he aware that footpath erosion results from too many people walking along the same paths? Is not it important to keep access open throughout the national parks? Will he confirm that he does not in any way support landowners in the North Yorkshire national park authority who wish to take away the public's freedom of access and, in so doing, threaten public access throughout the country?

Mr. Trippier: I am happy to confirm to the hon. Lady and the House that the Government, particularly the Department of the Environment, through the Countryside Commission, are very much in favour of improved access to the countryside, but on authorised routes and recognised footpaths that are legally marked on maps. I know that the hon. Lady would support that.

Local Government Finance

Mr. Devlin: To ask the Secretary of State for the Environment how many suggestions he has received for alternatives to the community charge for the raising of local government finance.

The Minister for Local Government and Inner Cities (Mr. Michael Portillo): We have received a number of such suggestions. However, it is clear that the community charge is the fairest of the options because it is based on the principle that everyone should pay something for the cost of local authority services. No other system makes local government as accountable to the electors.

Mr. Devlin: Is not it remarkable that my hon. Friend has not yet received the Labour party's promised policy paper? Is not it the duty of any party that seriously expects to enter government at some stage to put forward its proposals? The Labour party has plenty to say in criticism of our proposals, but nothing of its own to put forward.

Mr. Portillo: As my hon. Friend says, it is truly remarkable that the Labour party has not come up with an alternative. In its recent policy document it promised to publish that day a background paper setting out its proposals for local government finance. There was no background paper. I suspect that there is no background. The Labour party has no idea what it wishes to do about local government finance and that is why the deafening silence goes on.

Mr. Frank Cook: Will the Minister take it from me that come the next general election the Labour party will have clearly stated its proposals on the matter—[Interruption.]

Mr. Speaker: Order.

Mr. Cook: Will the Minister also take it from me that at that time the hon. Member for Stockton, South (Mr. Devlin) will very much regret his flippancy this afternoon?

Mr. Portillo: The hon. Gentleman is a great optimist. I wish that I could share his optimism. The Labour party has been considering local government finance for 11 years and has been unable to come up with any answers. I see no reason why the hon. Gentleman should believe that another two years will give the Labour party the breakthrough that it needs. By the next general election,


the basic fairness of the community charge will be well understood—certainly its great superiority to the rating system which is favoured by some Opposition Members.

Mr. Tracey: I am pleased that my hon. Friend is robust in defence of the fairness of the community charge, and I hope that he will continue to be so. But in his deliberations will he look closely at the standard community charge and the iniquitous suggestion by some local authorities that it must always be at the two times multiplier?

Mr. Portillo: Of course I will consider my hon. Friend's point. This is an area where the Government wished local government to be local. It is an area where we gave discretion to local authorities to apply multipliers on the standard community charge up to a maximum of two. I regret that not all local authorities took seriously enough the consideration of what multiplier should apply to different classes of people and I am now looking carefully at that.

Mr. O'Brien: Because of the great concern throughout Britain at the likely levels of the poll tax next year, when does the Minister intend to announce his alternative to his poll tax? In addition, may we be told when he intends to lay before the House for debate the Government orders spelling out the budgets of councils which he has poll tax-capped? Will he confirm that the delay in making those orders is due to the fact that the Secretary of State has now admitted using information that he received from Tory councillors on Calderdale, Derbyshire and Haringey councils in fixing their authorities' budgets? When does the Minister intend to bring forward his alternative to his poll tax?

Mr. Portillo: The hon. Gentleman misunderstands the position. We are not bringing forward an alternative to the community charge: we are looking at any anomalies in the system. I hope that we shall be able to make an announcement on at least some of those before the summer recess. There has been a judgment today from the Appeal Court and I believe that the way is clear for my right hon. Friend the Secretary of State to lay before the House the remaining draft orders and, if the House approves them, to make orders stating the final caps for the authorities.

Mr. Cran: Will my hon. Friend take it from me that my constituents find the community charge perfectly acceptable, but that they do not find acceptable the fact that Labour-controlled Humberside county council used the introduction of the charge to increase its expenditure by about 11.75 per cent. and they will have no early opportunity to oppose that at the ballot box? Moreover, most of the other districts in Humberside benefit from the safety net, but mine do not. Will he consider that in his review of the charge?

Mr. Portillo: I have told my hon. Friend and the House that we will carefully consider any new evidence on the standard spending assessments.
I had the pleasure of making a speech in Humberside on Friday evening, when I was able to make the point that the very high spending and the very large increase in spending by Labour-controlled Humberside council has resulted in much higher community charges than would otherwise

have been justified; and that, of course, has been the main cause of the high charges borne by my hon. Friend's constituents.

Norfolk Broads

Mr. John D. Taylor: To ask the Secretary of State for the Environment what rights the local community has in the management of the Norfolk Broads; and if he will make a statement on protection of the environment in the Norfolk Broads.

Mr. Trippier: Under the Norfolk and Suffolk Broads Act 1988, the development, conservation and management of the Norfolk Broads is the responsibility of the Broads Authority which consists of 35 members, over half of whom represent local authorities. Thus they play their part in all aspects of the management of the Broads. The protection of the Broads environment is a prime objective of the Broads Authority, endorsed by the Government, and its commitment to that has been amply demonstrated since it came into being in April last year.

Mr. Taylor: Is the Minister satisfied with the work of the new Broads Authority in its first year of operation? When can we expect a report on that work? As the Minister has stressed that more than 50 per cent. of the members of the new authority are elected representatives of the local community, is not it a desirable formula to have local people involved in the management of such an important area, and will he commend that formula to similar areas elsewhere in the United Kingdom?

Mr. Trippier: I shall certainly consider the hon. Gentleman's first point and whether we can make available a report for all hon. Members to see.
As for the hon. Gentleman's second point—I am certain that this is the point he is making—I noticed that on 21 June he asked a similar question about the replication of that model in Northern Ireland, to which my hon. Friend the Parliamentary Under-Secretary for Northern Ireland replied that he was prepared to become involved in further discussions about Strangford lough in particular. I am sure that the right hon. Gentleman welcomed that assurance and will take advantage of it if he sees fit.

Mr. Bellingham: Is my hon. Friend aware that since the new integrated conservation management approach introduced by the Act came into place this unique national asset has been safeguarded for future generations? Will he join me in paying tribute to the Norfolk people and to the one or two Suffolk people who have played a part in the new structure? Does he agree that if the people living around Strangford lough want to learn about conservation they need look no further than Norfolk?

Mr. Trippier: If this carries on we shall have a twinning arrangement between Strangford lough and my hon. Friend's constituency—which may not be too bad an idea. I am happy to pay tribute to the Broads Authority. My hon. Friend may recall that I had the opportunity to do that in the Standing Committee examining the Environmental Protection Bill.

Mr. Dalyell: What have Ministers learnt from the ongoing saga of Halvergate marshes, which featured so


much in the Committee stage of the Wildlife and Countryside Act 1981? Have they learnt anything about the management of wetlands?

Mr. Trippier: I think that we have learnt a great deal and that that has transposed itself into legislation which we hope will come forward from the European Community.

Green Belt

Mr. Fishburn: To ask the Secretary of State for the Environment how many acres of green belt have been lost to urban development in the last seven years; and if he will make a statement.

The Minister for Housing and Planning (Mr. Michael Spicer): The total area of approved green belt has more than doubled over the past 11 years; any loss to urban development will have been minute by comparison.

Mr. Fishburn: Although I am grateful for the Government's rigour in conserving the green belt, can my hon. Friend assure me that the Department will be equally rigorous in preventing development in conservation areas in the inner cities? For instance, two thirds of Kensington qualifies as a conservation area. Will my hon. Friend provide for inner London the same oases of calm as the green belt provides for suburban areas?

Mr. Spicer: The Government wholly support the concept of conservation areas. Their designation is a matter for local authorities, and whether designations should be more widespread is a subject of a current consultation paper on demolitions, responses to which were due this Monday.

Mr. Ron Brown: Will the Minister have a word with his Scottish colleagues and make it clear that Mr. Wallace Mercer, that great entrepreneur, should not be given permission to seize part of Edinburgh's green belt for his super-duper stadium? We should remember that Mr. Mercer is interested only in the fast buck and not in the Hearts or Hibs supporters who have got a squalid deal all the way through this sorry tale which is repeatedly mentioned in the Scottish press.

Mr. Spicer: As the hon. Gentleman says, that is not a matter for me. I shall certainly make sure that my right hon. and learned Friend the Secretary of State for Scotland hears what the hon. Gentleman says.

Competitive Tendering

Mr. Norris: To ask the Secretary of State for the Environment if he will make a statement on the progress of the implementation of compulsory competitive tendering in local government.

The Parliamentary Under-Secretary of State for the Environment (Mr. David Heathcoat-Amory): Competitive tendering for construction and maintenance work has been compulsory since 1980. It was extended to a range of services, such as cleaning, refuse collection and vehicle maintenance by the Local Government Act 1988. It is being phased in and the first two rounds of competition are complete. The results have been encouraging, and it is clear that competition has done a great deal to improve efficiency and secure better value for money.

Mr. Norris: I thank my hon. Friend for that answer. Does he agree that there is no room in the philosophy of either socialism or the free market for waste and that the greatest benefit of competitive tendering is the elimination of waste? On behalf of all those who enjoy the services that are provided by local authorities throughout the country, may I urge him to continue the vigorous programme of competitive tendering that has been undertaken by the Government to ensure maximum value for money for taxpayers and all service users?

Mr. Heathcoat-Amory: My hon. Friend is entirely right. Compulsory competitive tendering is a potent weapon in the hands of local authorities to secure high-quality services at the most competitive price.

Mr. Hardy: Is there any prospect of the Government adopting for their own responsibilities the safe practices that they now require local government to pursue? If he cares to read the Official Report of the debate on electricity privatisation he will see that if the rules that his Department is seeking to impose on local government were to apply to central Government some occupants of the Treasury would face surcharge or imprisonment.

Mr. Heathcoat-Amory: We are always looking for new areas in which to introduce the benefits of open competition. I regret that the Labour party is apparently seeking to undermine that by withdrawing the requirement that competition should be compulsory. We are on the side of the charge payer and against the empire builders in some local authorities.

Mr. Michael Brown: Can my hon. Friend report on the position in Humberside? Can he confirm that he has had to issue a section 13 notice because that county council, in flagrant disregard of the charge payers in the county, is failing to operate the competitive tendering requirements of our policy?

Mr. Heathcoat-Amory: Yes, Sir. Humberside has been issued with a section 13 notice because of apparent anti-competitive behaviour during the tendering round. The council is now required formally to account for its actions. My right hon. Friend the Secretary of State has further sanction powers that he will not hesitate to implement if the evidence warrants it.

Football Stadiums

Mr. Pendry: To ask the Secretary of State for the Environment when his Department's draft consultation document on issues of planning policy guidance on the considerations relevant to new and redeveloped stadiums for Football League clubs will be issued.

The Parliamentary Under-Secretary of State for the Environment (Mr. Conn Moynihan): My right hon. Friend the Secretary of State hopes soon to issue a draft planning policy guidance note on sport and recreation matters, and it will also deal with all-seater Football League stadiums.

Mr. Pendry: I do not know whether I should be thankful for that laid-back reply. Now that the Under-Secretary of State has been stripped by the Home Office of most of his football responsibilities, at least we cannot blame him for not setting up the Football Licensing Authority. As he has extra time on his hands, will he at least get to grips with his remaining


responsibilities and give clear guidance to the football clubs on the safety standards laid down by Lord Justice Taylor? It is clear that the clubs are much more anxious than the Government to implement Taylor's proposals.

Mr. Moynihan: That clear guidance has been given and as soon as the Football Licensing Authority has been established, the guidance will be reinforced.

Mr. John Greenway: Although everyone associated with football regrets the delay in implementing the proposals and setting up the licensing authority, does my hon. Friend agree that it is better that we get such matters right and that the right people are appointed to the authority? Does he accept that, in any event, the interim recommendations of Lord Justice Taylor's report have already been implemented by most clubs?

Mr. Moynihan: I agree completely with my hon. Friend's second point. Several clubs have taken positive action to pursue the recommendations in Lord Justice Taylor's interim report. I shall pass the comments that my hon. Friend made in the first part of his question to my right hon. and learned Friend the Home Secretary.

Mr. Menzies Campbell: Does the Minister agree that if all 92 clubs in the Football League are to have the stadiums that their spectators deserve, some imagination will have to be shown by those who propose developments and more particularly by the local authorities to which such proposals are addressed?

Mr. Moynihan: Yes, I agree completely. It is precisely for that reason that relevant paragraphs will be included in the planning policy guidance note that will be issued shortly.

Mr. Hind: My hon. Friend will be aware that Liverpool, one of the clubs which participated in the match at Hillsborough where the tragedy that gave rise to the Taylor report took place has endorsed the concept of all-seater stadiums. Does my hon. Friend agree that the remarks of Lord Justice Taylor and the policy of the Government have been endorsed by the behaviour of the crowds at the World Cup, who were mainly in all-seater stadiums? There have been almost no incidents in the grounds.

Mr. Moynihan: I agree completely with my hon. Friend.

Mr. Ashton: Is not it 15 months since 95 people were killed at Hillsborough, one year since the legislation went through the House and three months since cash was promised in the Budget? Yet the whole system of improving grounds has been held up by the bureaucracy at the Minister's Department and at the Home Office. The two Departments simply cannot agree on the chairman of the committee and the setting up of the Football Licensing Authority. Since then we have had the riots at Bournemouth. The four years laid down for putting seats in stadiums has been eaten away and soon there will be only three years left. The whole scheme is in danger of being postponed and further accidents may take place because the Home Office and the Department of the Environment cannot get their act together.

Mr. Moynihan: The hon. Gentleman is talking nonsense. If he had listened to the comments of my hon. Friend the Member for Ryedale (Mr. Greenway) and my

reply he would have learnt that many clubs have been responsible and moved ahead with the recommendations in their own right.

World Cup

Mr. Alex Carlile: To ask the Secretary of State for the Environment what representations he will be making to UEFA concerning the behaviour of England fans at the World Cup.

Mr. Moynihan: I have agreed with the president of UEFA that it would be unwise of the Government to take a view on the return of English clubs to European competitions until we are able to assess the behaviour of English supporters in the 1989–90 domestic season and throughout the World Cup. I will provide my assessment to UEFA as soon as possible.

Mr. Carlile: Will the Minister join me in congratulating the vast majority of English fans at the World Cup who, together with their Scottish and Irish friends, have behaved extremely well? Does he agree that although the Italian police perhaps stepped beyond the bounds on several occasions, they have shown the value of dealing with trouble well away from the ground? Will the Minister make representations to UEFA that it is far better to identify troublemakers and deal with them severely, in whichever country they are caught, than to penalise the whole of English football by keeping it out of international competition?

Mr. Moynihan: I, too, recognise that the overwhelming majority of English supporters have gone to Italy to enjoy a festival of football and have behaved admirably.
The hon. and learned Gentleman's second point was on Italian police activity. I join him in commending the Italian police for taking tough, effective and swift measures to contain the incidents of violence.
With regard to the hon. Gentleman's third point about action by the courts, I agree that other countries in Europe and, indeed, elsewhere in the world would do well to introduce measures which allow their countries to take action against people convicted of football-related offences in the country where the football match took place. We have led the way through part II of the Football Spectators Act 1989 and I hope that other countries will follow.

Mr. Burt: Is not it the case that a number of the measures that my hon. Friend fought for with the Italian authorities in relation to Sardinia, particularly the bans on alcohol near the ground, and the ferry bans, have been particularly effective as was his work with the football intelligence unit in identifying hooligans before they reached Sardinia? Is not it a disgrace that my hon. Friend's efforts on behalf of this country are constantly being undermined by yesterday's Minister, the right hon. Member for Birmingham, Small Heath (Mr. Howell), who has failed to have the good grace to welcome all the efforts that my hon. Friend has made, the majority of which, in the first stage of the competition, were entirely successful?

Mr. Moynihan: I am grateful to my hon. Friend for his comments. The Government have always taken the view that it is important to be pro-active and to work closely with the Italian authorities to put in place as many layers of deterrence against hooliganism as possible. We have


been working hard for more than 14 months and have joined the Italian authorities in more than 120 measures to deter the hooligan element. I deeply regret that a tiny minority is still intent on hooliganism and continues to cause trouble. However, we shall continue throughout the rest of the World Cup to work closely with the Italian authorities, as we have done to date, to make sure that any measures required to stamp out hooliganism have the full backing and support of this Government.

Mr. Fraser: Millions of peace-loving fans want to see England back in European football. I congratulate the hon. Gentleman on what he has done, but will he confirm that he intends to play vigorously on their side to get English football back into Europe?

Mr. Moynihan: I have made it absolutely clear to the House that the overwhelming majority of football supporters have behaved well during the World Cup and I shall make it clear to UEFA that where there have been incidents of violence involving English supporters, a comprehensive report—based on police evidence and my officials' reports, not on newspaper headlines—will form part of the full report which goes to UEFA at the end of the World Cup.

Mr. Charles Wardle: Is my hon. Friend really able to assure UEFA that British football management is sufficiently determined to meet hooliganism with touch discipline? If the Football League can relegate Swindon town from division 1 to division 3 because of the behaviour of a couple of crooks, why did it not demote Leeds united from division 1 to division 4 because of the criminal behaviour of 200 hooligans who laid waste a number of seaside towns?

Mr. Moynihan: My hon. Friend has made his point very clearly. I have no doubt that the Football League will pay due attention to it.

Mr. Denis Howell: May I advise the Minister that this afternoon I have requested a meeting with the president of UEFAH—[HON. MEMBERS: "Oh!"]—to make sure that he fully understands that the Minister's policies lie in ruins, as we predicted, and to assure him that the Minister's increasingly frenzied utterances, particularly about innocent people who have been deported without trial, have no support on the Opposition Benches or among responsible people? What steps has the Minister taken to tell the Italian authorities that to round up and deport people, some of whom were tourists, miles away from the scene of the incident, is a disgrace and that every citizen is entitled to defend himself and his reputation under Italian, English and European law? [Interruption.] May I say to the Minister—[Interruption.]—

Mr. Speaker: Order. The right hon. Gentleman should ask a question, not make a statement.

Mr. Howell: May I ask the Minister to follow the policy on which we have supported him—that guilty people should be prosecuted and dealt with, but that innocent people should be presumed not guilty rather than being rounded up as they have been? [Interruption.] It was clear that Conservative Members—[Interruption.]

Mr. Speaker: Order. This is Question Time, and I must ask the right hon. Gentleman to be brief.

Mr. Howell: I can assure you, Mr. Speaker, that when I started this question, it was quite a short question.
May I finally say—

Hon. Members: No.

Mr. Speaker: Order. I must ask the right hon. Gentleman to make his final comments brief.

Mr. Howell: That is my intention, Mr. Speaker.
Finally, I ask the Minister to reflect on the monstrous mass libel of guilty and innocent alike represented by the comments that he is reported in this morning's press to have made—that they are criminally motivated. The guilty should be prosecuted but people who have claimed that they are innocent and have not been given the opportunity to prove it should not be convicted by such mass libel.

Mr. Moynihan: When the right hon. Gentleman studies the record, he will see that he has echoed the pleas of the louts who comprise football's effluent tendency. The Government stand shoulder to shoulder with all decent people in this country who condemn the criminally motivated minority of so-called England fans. I remain firm in my support for the tough, swift and effective policing that has undoubtedly contained incidents which could have escalated to levels that we have seen all too often in the past.
I am surprised that the right hon. Gentleman has only this morning decided that he wishes to seek a meeting with UEFA. He was in Italy for 10 days at the same time as the president of UEFA; he could perhaps have seen him then.

Mr. Howell: rose—

Mr. Speaker: No.

Private Rented Accommodation

Mr. Winnick: To ask the Secretary of State for the Environment how many new tenancies he expects will be created by private landlords during 1990–91.

Mr. Michael Spicer: There are clear signs of increased activity in the residential letting market following the Housing Act 1988. I want to speed up this revival of the private rented sector.

Mr. Winnick: Why does the Minister not admit that recent legislation has totally failed to provide rented accommodation for people who desperately need it because they cannot afford to buy? There is no evidence whatever that such accommodation is being provided in the private market. Given the current crisis in the Housing Corporation, and as interest rates continue high, why do not Ministers allow local authorities to start building houses again and providing the accommodation that is so desperately needed? Why should those desperately in need of accommodation be penalised because of the selfishness and dogma of Tory Ministers?

Mr. Spicer: There are two problems facing the private rented sector—to that extent, I agree with the hon. Gentleman. The first is that, for years, we have undermined the role and function and the self-confidence of the private landlord. The second is that there is a blight hanging over the private rented sector due to the pronouncements of the Labour party, particularly those to the effect that it would sequester private property and again involve itself in rent control and total tenure. If the


hon. Gentleman has a problem, perhaps he should have a word with his own Front-Bench spokesmen and get them to remove that blight.

Mr. Patrick Thompson: Does my hon. Friend agree that the anti-private-sector policies of Norwich city council and other Labour councils which preside over large council estates with increasing numbers of empty houses will serve only to increase the number of homeless people in my constituency and others?

Mr. Spicer: I could not agree more with my hon. Friend. Housing authorities throughout the country, particularly Labour housing authorities, are sitting on 100,000 vacant council houses. Because of the points that I made in answer to the first question, there has been little incentive for potential private landlords to bring the 600,000 vacant properties on to the market. At the very least, as a priority, we must get our existing housing stock properly used.

Mr. Trimble: While one wishes to see a considerable increase in the supply of rental property, does the Minister consider that more needs to be done than just removing rent controls? Has he considered the experience in Northern Ireland, where there has been no rent control whatever on new-build properties since 1956, without producing any increase in supply? Does he agree that other measures are necessary to increase the supply of property?

Mr. Spicer: Yes, Sir. I am giving serious consideration to what other measures need to be introduced in the way that the hon. Gentleman suggests. For instance, it should be made easier for people, especially elderly people, to let property. I am having discussions about whether we could use housing associations on a contract basis to manage some properties for elderly landlords. There is also the question whether the law is moving swiftly enough. There are plans as from next April to make it much easier for landlords to have their contracts applied. That is extremely important. We are considering other measures to do exactly as the hon. Gentleman suggests and to make the private rented sector much more effective than it has been in the past.

Competitive Tendering

Dr. Twinn: To ask the Secretary of State for the Environment what savings he estimates could be made throughout local government by the introduction of competitive tendering and other efficiency measures.

Mr. Heathcoat-Amory: Earlier this month the Audit Commission identified possible savings in local government of £1,328 million, of which about 50 per cent. has been achieved. Competitive tendering has been a powerful element in reducing those costs, but clearly there are very large savings still to be made.

Dr. Twinn: I am grateful to my hon. Friend for that answer. Does he agree that failure to implement competitive tendering is a fraud on the community charge payer, that local authorities that are not implementing competitive tendering properly are probably pandering to the interests of local trade unions, which are totally opposed to the interests of local residents and will mean a higher community charge?

Mr. Heathcoat-Amory: I agree with my hon. Friend. Compulsory competitive tendering is an indispensable mechanism for ensuring high-quality services at lower cost. It is a matter of regret, although hardly surprising, that the Labour party is therefore against it.

Mr. Nellist: If the Minister is serious about savings for local authorities through greater efficiency, will he have a word with the Secretary of State for Energy about the pricing policy of British Gas? Is he aware that yesterday the finance committee of Coventry city council decided to turn up the heat in 14 schools and old people's homes and open the windows to use an extra 56,000 therms of gas before November so as to qualify for a £30,000 lower bill from British Gas? What is the point in the Prime Minister, across the water this morning, giving £5 million to combat global warming when we in Coventry have to burn more gas to save money?

Mr. Heathcoat-Amory: Energy pricing is a matter for my right hon. Friend the Secretary of State for Energy, but it is clear that privatisation of the electricity industry will be a powerful factor in controlling energy costs in the future.

Mr. Holt: Does my hon. Friend agree—[Interruption.]

Mr. Speaker: Order.

Mr. Holt: Would my hon. Friend agree that the Government's policy on competitive tendering is very good? Will he consider the implementation, particularly by Middlesbrough council, which seeks to find a way around almost everything when it comes to competitive tendering? It recently awarded a contract for security services to a company which it set up with one of its councillors on the board, which did not have employees, against a proper tender submitted by a recognised and long-standing security firm? At the end of the day the tender was a small amount in favour of the newly-formed company, as can happen with a system in which only the chairman of the committee opens the tenders. Is not it time, therefore, for the Government to ensure that at least one person from the opposition can be on the tender committee when the documents are opened?

Mr. Heathcoat-Amory: The 1988 Act gives my right hon. Friend the Secretary of State sanction powers against local authorities that have apparently acted anti-competitively. If my hon. Friend the Member for Langbaurgh (Mr. Holt) has evidence, he should submit it and I will ensure that it is drawn to the attention of officials and of my right hon. Friend the Secretary of State.

Mr. Tony Banks: Does the Minister accept that there was more than a little hypocrisy surrounding the answers given by Ministers about financial efficiency and local government? Financial efficiency in local government is acres and years ahead of the Government, given the over-run and overspend in the Ministry of Defence. If such overspending were translated into local government, councillors would be surcharged, as they have been in Lambeth, and would end up in gaol. It is time that the Government accepted the restrictions that they place on local government.

Mr. Heathcoat-Amory: I am disappointed that the hon. Gentleman seeks to overlook the undoubted examples of waste and extravagance among local authorities.


Compulsory competitive tendering is necessary, and I should be more interested in the hon. Gentleman's attitude to that.

City Action Teams

Mr. Arbuthnot: To ask the Secretary of State for the Environment if he will make a statement on the progress of the work of the city action teams.

Mr. Portillo: City team actions exist to make the most from the Government's substantial programmes for inner-city areas. They encourage co-operation between central and local government and between business and the voluntary sector so as to bring regeneration to inner cities and to benefit their residents.

Mr. Arbuthnot: Does my hon. Friend agree that city action teams play a vital role in the Government's £4 billion programme to revitalise the inner cities while Labour's candy floss document, "Looking to the Future", contains not a section and barely a word about inner cities? Does not that tell us something about Labour's commitment to the inner cities, compared with the Government's record?

Mr. Portillo: As my hon. Friend says, it is an extraordinary omission. The period of the last Labour Government was not a good one for inner cities. We are perfectly used to inaction by the Labour party, but to lack even rhetoric and promises about the inner cities is remarkable indeed and certainly contrasts with the £4 billion per year programme of Government aid for inner-city areas. I am pleased to say that that programme is flourishing, helped by the city action teams.

Mr. George Howarth: Does the Minister realise that, given the crisis in inner cities and the housing crisis throughout the country, the programme is insignificant and little is happening? Is he aware that the Housing Act 1988, to which the Under-Secretary of State referred, is in tatters without one housing action trust being set up, no voluntary transfers and absolute chaos in the Housing Corporation? Instead of all the talk, will the Government do something about housing and the inner-city crisis?

Mr. Portillo: I must overcome my disappointment that the hon. Gentleman did not tell us his party's policy on inner cities, given that the absence of such a policy has been pointed out. The hon. Gentleman's comments about results under this Government were untrue. He will know that the urban development corporations have attracted £7 billion of private investment, much of which is being spent on housing. City grants, and the predecessors, are supporting 430 projects and leading to the construction of 11,800 homes, among other things. When I say "among other things", I mean 47,000 jobs and a further £1 billion of private sector investment. If the hon. Gentleman does not know what is going on in the inner cities he must be going round blindfolded.

Mrs. Maureen Hicks: Does my hon. Friend agree that whatever progress is made by city action teams in improving the quality of life for inner-city residents, one of the greatest environmental problems still to be tackled is the war against litter, graffiti and vandalism? Does he agree that we must do all that we can to encourage community initiatives? Will he pay particular tribute to the

initiative being taken by the Wolverhampton Express and Star. with its "litter busters" initiative, to try to clean up the black country and to involve young people in that activity?

Mr. Portillo: I welcome campaigns of that sort. My hon. Friend is absolutely right that it is important to keep sites free from litter and dumping in order to raise the spirit of the area. The Government's actions are directed towards raising the level of economic prosperity so that regeneration will be self-sustaining. There is no point in investing in housing projects or whatever alone—one must raise the general level of prosperity to create a better environment in inner-city areas.

Local Authority Spending Assessments

Mr. Pike: To ask the Secretary of State for the Environment how many local authorities have made representations to his Department regarding their standard spending assessment.

Mr. Chope: A large number of local authorities have made representations about their standard spending assessments.

Mr. Pike: Does the Minister accept that if the standard spending assessment figures given to local authorities are too low, there will be serious implications for poll tax payers because that will force up the poll tax to a high level? Lancashire county council and many other county councils in the north-west, like councils throughout the country, have made representations about their SSAs. Does the Minister accept that when the Secretary of State meets local authority associations later this year he should not only discuss the matter but respond positively by ensuring that an increase in the figures next year so that poll tax levels can be reduced considerably?

Mr. Chope: My right hon. Friend the Secretary of State always responds positively to propositions. There is too much evidence that high-spending local authorities try to use SSAs as a scapegoat for their inefficiency and extravagance. Certainly, that is true of Burnley and Lancashire. In Burnley, the SSA is 17.5 per cent. higher than its grant-related expenditure equivalent last year, yet spending increased by 25 per cent. That shows that the high community charge in Burnley is fairly and squarely the responsibility of the socialist council and the socialist Lancashire county council.

Mr. Donald Thompson: Will my hon. Friend congratulate the citizens and local government officers in Calderdale on collecting the community charge at about the same rate they collected rates in the past? When he looks at SSAs will he take into account areas of special geographic difficulty, such as Calder Valley which has numerous roads which are often affected by bad winters and about which I have approached the Department year after year?

Mr. Chope: I shall convey my hon. Friend's congratulations to those responsible and I assure him that, as always, we shall listen to his representations carefully.

Mr. Soley: Does the Minister appreciate that if he does not tell us how many local authorities made representations, a great many of which were Conservative, we shall conclude that he cannot count, which is quite likely to be


right? Can he also tell us the answers to the important questions of how many local authorities, both Conservative and Labour, have asked for their SSA to be reassessed because it is too low, and whether or not part of the changes that the Government make to the poll tax will include increasing SSAs to meet the requirements of Conservative and Labour local authorities.

Mr. Chope: The Government are more interested in the quality of representations than in their number. This year there has been a 10 per cent. increase in SSAs compared with the GRE assessments for last year. That is above the rate of inflation. The hon. Gentleman must face the fact that the much higher than expected community charges are due not to inadequate SSAs but to the high-spending policies of so many councils.

Recycling

Mr. Batiste: To ask the Secretary of State for the Environment what initiatives he is taking to promote recycling by waste collection authorities.

Mr. Heathcoat-Amory: The Environmental Protection Bill will require waste collection authorities to draw up and publish plans to recycle material in their area. The Bill also gives them a direct financial incentive to recycle waste rather than send waste for disposal.

Mr. Batiste: As an important measure to encourage more recycling, will my hon. Friend consider passing credits from waste disposal authorities to waste collection authorities and also to voluntary bodies if they can come forward with viable schemes for waste recycling?

Mr. Heathcoat-Amory: Yes, Sir. Under the provisions of the Environmental Protection Bill, waste collection authorities will receive financial credits for material that they recycle rather than send for disposal. Voluntary bodies and agencies may also receive such financial assistance. My right hon. Friend the Secretary of State can require them to be paid the money if circumstances warrant it. That should be a powerful incentive to local recycling efforts.

Mr. Faulds: Will the hon. Gentleman tell the House and the country what became of the initiative launched by the Prime Minister under the leadership of Richard Branson?

Hon. Members: Who?

Mr. Heathcoat-Amory: If the hon. Gentleman is referring to the voluntary initiatives on litter, those are still going ahead and are very successful.

Mr. Nicholas Bennett: My hon. Friend will be aware that Walworth road is in the borough of Southwark. Will he consider giving special assistance to that council to deal with the horrendous piles of waste paper along that road, much of which is entitled "Labour's Alternative to the Community Charge" and appears to have been recycled on a number of occasions already?

Mr. Heathcoat-Amory: I believe that there is a lot of waste and rubbish around Walworth road which has already been recycled fairly extensively and it may be better now to send it for disposal.

Drinking Water

Mr. Fearn: To ask the Secretary of State for the Environment when he expects all British drinking water sources to comply with European requirements for maximum pesticide residue levels.

Mr. Trippier: It is not possible to give a date for full compliance with the standard in the EC drinking water directive for pesticides, because this particular standard is not, in our view, technically achievable by any member state. The trace amounts of pesticide found in a small proportion of United Kingdom drinking water supplies are not regarded by the Government's medical advisers as posing a danger to health. The Government require water companies to carry out regular monitoring for pesticide residues and, where appropriate, to develop the technology for their removal and investigate, with the National Rivers Authority, the case for restricting the use of pesticides in the areas from which they draw water.

Mr. Fearn: Is the Minister aware that reports today state that two thirds of London's drinking water is now contaminated with unacceptable levels of pesticides? What do the Government intend to do about that? Thames Water has until some time in the next century to bring its water up to EC standards. Is that timetable to be altered?

Mr. Trippier: I have already asked for a report on the pesticides identified in Thames Water supplies. However, at this stage I must say that the Government's medical advisers are satisfied that the trace amounts of pesticides revealed by extensive monitoring in the United Kingdom generally do not endanger public health. I am sure that the hon. Gentleman will join me in not wishing to scaremonger in any way. For a number of supplies, suitable technology for full-scale treatment to remove pesticides and other trace organic substances will probably not be available for any country anywhere for the next five years.

Mr. Gow: Is not it an impertinence for folk in Brussels, however eminent, to lay down conditions for the quality of drinking water in the United Kingdom? Ought not it to be a matter for the House and for the Government to determine the quality of our drinking water?

Mr. Trippier: My hon. Friend places me in a difficult position. As he knows, we are a keen, active and positive member of the European Community and we participate actively at European Council meetings of Ministers. I am pleased to reassure my hon. Friend that the standards that we set on a national basis, which are incorporated in legislation, are higher than and superior to what the European Community directs us to do.

Mrs. Ann Taylor: If, as the Minister says, the Government are such a keen and active member of the European Community and are so proud of Britain's record, why is he so active in Brussels in blocking proposals to make it easier to introduce future improvements in standards in the EC directive on drinking water quality? Is not that another sign of the Minister's negative attitude to Brussels and total complacency about drinking water quality?

Mr. Trippier: I am sure that the House will forgive me if I refuse to take lectures from the hon. Lady about anything to do with drinking water when I recall what the


Labour Government did when they were last in office, dramatically cutting the money available to the water authorities. I am glad to be able to tell the House that we are leading the way on water initiatives, which have been raised at the meetings of the European Council of Environment Ministers. The hon. Lady, along with her right hon. and hon. Friends on the Opposition Front Bench, seems determined to take every possible opportunity to do the country down and sell it short. That seems to be Labour's new tactic, but I can hardly believe that it would commend itself to the electorate.

Sewage Discharges

Mr. Michael: To ask the Secretary of State for the Environment if he will take immediate steps to ensure that sewage discharged into estuaries around the United Kingdom is treated from the earliest possible date, to ensure immediate re-design of any planned developments including long sea outfalls to incorporate full treatment, and to provide Government finance to meet these commitments.

Mr. Heathcoat-Amory: The Government have already taken steps to require that sewage discharged to estuaries and coastal waters is treated from the earliest possible date. All new developments will incorporate treatment, and arrangements are in hand to establish treatment works

at existing outfalls. Because of successful privatisation, the £3 billion required is available without recourse to the Treasury.

Mr. Michael: The Minister has failed to give the simple reassurance for which my question asked—that sewage outfalls such as that at Lavernock will be treated. They are still at the planning stage, so there is time for the Government to make that change and to show that they mean what they say. There is a suspicion in Europe that the Government do not mean what they say. Those of us who served on the Committee on Water Bill last year also suspect that they do not. Can the Minister tell us that outfalls such as Lavernock will be treated, that the change will be made now, when there is still time, and that the Government mean what they say?

Mr. Heathcoat-Amory: Long sea outfalls which have not yet been started will include treatment. Projects already in hand or not yet started will include treatment at a future date.

STATUTORY INSTRUMENTS, &amp;c.

Ordered,
That the draft Meat and Livestock Commission Levy (Variation) Scheme (Confirmation) Order 1990 be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Welfare of Livestock Regulations 1990 be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. Nicholas Baker.]

Points of Order

Sir John Stokes: On a point of order, Mr. Speaker. In view of the great parade in London today, representing so many facets of our national life, to celebrate the 90th birthday of Queen Elizabeth the Queen Mother, would you be good enough on our behalf to send Her Majesty the best wishes of the House of Commons?

Mr. Speaker: I understand that there may be an opportunity to do that officially a little later in the year. However, I share the hon. Gentleman's view and look forward to going to the parade myself this evening.

Mr. Dave Nellist: On a point of order, Mr. Speaker.

Mr. Speaker: The same point? [Laughter.] Order.

Mr. Nellist: On a different point of order, Mr. Speaker. Although I realise that you are not responsible for the answers that Ministers give to questions, you will recall that, in a supplementary question to question 10, I raised the appropriate matter of local authority efficiency and asked the Minister whether he would contact the Department of Energy about a matter relating to British Gas. However, the Minister replied on the subject of electricity, which had nothing whatsoever to do with the question. Is there any possibility of you having a word with either the Leader of the House or the Patronage Secretary to ascertain whether we can get the quality of the Ministers at the Department of the Environment up a peg or two?

Mr. Speaker: The hon. Gentleman knows that that is not a matter for me. I am not responsible for answers. It might have been a slip of the tongue.

Mr. Barry Field: On a point of order, Mr. Speaker. My hon. Friends and I at this end of the Chamber distinctly heard the right hon. Member for

Birmingham, Small Heath (Mr. Howell) shout to my hon. Friend the Minister for Sport that my hon. Friend is the biggest football hooligan in the country. That demonstrates the right hon. Gentleman's complete lack of knowledge because I have it on the most excellent recommendation that one or two others are even larger than my hon. Friend. The right hon. Gentleman should be asked to withdraw that comment which shows his complete lack of knowledge and an inability to discharge his duty.

Mr. Speaker: I am afraid that things are occasionally said from a sedentary position, but they do not form part of our parliamentary proceedings. I did not hear that particular remark, and I am sure that the Minister concerned is not thought of in anything like those terms.

Sir Nicholas Fairbairn: rose—

Mr. Speaker: Order. We must move on, for we have a very busy day ahead of us.

Sir Nicholas Fairbairn: Further to that point of order, Mr. Speaker. I ask you to defend the House against such insults, particularly as "the tartan army", as it has been called, returned from the world cup without one of its members being arrested for anything. That matter is not one that I would wish to display against our dear friends south of the border.

Mr. Speaker: That seems to be a continuation of Question Time.

Mr. Geoffrey Dickens: rose—

Mr. Speaker: Order. I know that I have not been able to call the hon. Member, but is his a point of order or a point of frustration? Perhaps it is both.

Mr. Dickens: On a point of order, Mr. Speaker. There was an exchange in the House last week in which you were involved, and which I am afraid led to some bad publicity. May I personally apologise to you, Mr. Speaker, and to the House, for the embarrassment that I caused.

Mr. Speaker: That makes me feel very much better.

One-Parent Families

Mr. Julian Brazier: I beg to move,
That leave be given to bring in a Bill to amend the law in order to give local authorities greater discretion in providing accommodation for certain categories of one-parent families.
According to the Department of Employment's quarterly returns, 44 per cent. of people accepted by councils as homeless are in that category because their families, or in some cases their friends, have evicted them. That is a much more common cause of homelessness than divorce and the break-up of common law arrangements. My particular concern is with one category of homeless persons—girls and young women who are pregnant or who have recently produced babies.
Such girls account for 13 per cent. of homelessness cases—an increase of half the number 10 years ago. Recent statistics from the National Society for the Prevention of Cruelty to Children, "Child Abuse in England and Wales 1983–87", reveal that children in one-parent families are twice as likely to be sexually abused and six times as likely to fail to thrive as their counterparts in a normal two-parent arrangement. That is not meant as a criticism of the many lone parents—widows, divorcees, abandoned women, and in some cases abandoned men—who struggle bravely to bring up their children under difficult circumstances. Rather it is a sad reflection of the fact that a child in the early stages of its life often needs more support than a lone parent can provide.
I want to address two specific issues. The first is the eviction of pregnant young women by their parents—something that we now seem to accept as a matter of course. The other is the way that local authorities should cope with those who undoubtedly need rehousing. The Association of District Councils is concerned at the large number of young people becoming homeless, and recently recommended:
Where inquiries reveal that the person was within twelve months prior to applying to them as homeless or threatened with homelessness living with his parents or parent, guardian or guardians, he should be required to show to the satisfaction of the authority that the homelessness or threatened homelessness is genuine.
Under that male language is concealed the vital category of pregnant young women.
The statistic of 13 per cent. covers pregnant women only. It does not include the substantial number who have recently produced babies and have then been thrown out by their parents. I encountered an example of that a few weeks ago that I should like to share with the House.
A young woman in local-authority-supported accommodation came to my surgery with a number of problems with which I did my best to assist. She was 21, and during the course of the conversation it transpired that her parents were living just a couple of miles from her in an extremely comfortable house on their own. Her father had a regular job, but her parents had completely washed their hands of her. She had been away from home for more than 12 months, and I would not seek to change the law in her case, but the position would have been exactly the same legally if she had been living at home until the pregnancy.
As it stands, the law allows the parent to throw out any daughter aged over 16. That action has a double effect. First, other families who badly need accommodation are pushed down the housing waiting list. Secondly, the child

born to the lone parent is at a great risk, often from predatory boyfriends. As the statistics I have already cited show, the child of a lone parent is twice as likely to be sexually abused and six times as likely to fail to thrive as a child in a two-parent family. But those statistics understate the depth of the problem because they are based on one-parent families as a single category. That category includes several groups in which there is little extra risk to the child—for example, those lone parents who are widows, divorced women and abandoned wives. The risk to their children is very much lower than that faced by the child of a young single girl.
We must ask ourselves whether we believe that all parental obligations to daughters living at home end the moment they become adult. Let us remember that for the purposes of the present law a girl becomes an adult at 16, not even at 18. I believe that those obligations should not end. Sadly, as so often happens, custom and practice have followed just a few years behind the law. Because the House passed the Housing (Homeless Persons) Act 1977, which is aimed at a small category of genuine, difficult cases, it has now become a matter of course for many parents—one could almost say most—to wash their hands of their daughter and throw her out once she becomes pregnant.
At a time when the Government are rightly chasing fathers and stressing their financial obligations, it is also right that we should consider two other categories of obligation and duty. I propose two specific measures. First, it should become a civil law offence for parents to evict a pregnant daughter under 25 years of age who is living at home or has lived continuously at home in the previous 12 months when those parents have adequate accommodation. Councils would then be allowed to bring civil actions against such parents.
Secondly, there will always be young pregnant women looking for accommodation—perhaps there is no parental home or the girl has been living away from it for a long time. Young girls may also leave home because of overcrowding or a risk of violence. In such cases I believe that councils should have a right and a duty to consider placing younger girls in warden-assisted accommodation where proper supervision is provided to ensure that the child born is not at risk.
From my constituency case load I know of a woman who gave birth to her first child when she was extremely young. To begin with she lived alone. Social services told me that she produced a total of six children. They believe that each one came from a different father. During that time her transient boyfriends have abused the first five children—the fifth child was only two and a half years of age at the time. In such a case it would have been much better if, initially, that woman had been placed in some type of supervised warden-assisted accommodation.
My Bill seeks to shift the debate on this vital issue of such vulnerable children away from a discussion of rights towards a discussion of duties and obligations. The Bill deals with two sets of duties: first, the duties which parents should continue to have to their offspring which should not end when the child reaches the age of 16; and, secondly, the duties of local councils. Of course they should have a duty to unmarried mothers with a vital need for accommodation, but their first duty must be to the rights of the child. I urge the House to support my Bill.

Mrs. Alice Mahon: rose—

Mr. Speaker: Does the hon. Lady seek to oppose the Bill?

Mrs. Mahon: Yes, Mr. Speaker.
The Bill is more concerned with the discretion to refuse single parents housing. Its attitudes are rooted in the worst bigoted Victorian values. I suspect that it is aimed at a small number of people, but it will have wide and sweeping effects. It seeks partially to excuse the Government's disgraceful record on housing.
There is a crisis in housing and a great deal of homelessness, and single parents are particularly vulnerable, but the housing crisis is the Government's fault. The Bill goes much deeper than that, as it seeks to remove the civil rights of any single pregnant mother under 25. It seeks to punish them as it states that such a woman, who the hon. Member for Canterbury (Mr. Brazier) perceives to be a problem, has no right to a home of her own and should be herded into warden-assisted accommodation as if single mothers were somehow deviants. That is an outrageous suggestion which is probably entirely in keeping with the hon. Gentleman's and the Prime Minister's view of single parents. The Bill is in line with the Government's attempt to find a new scapegoat in single parents.
The chairman of the Tory party, the Chancellor of the Duchy of Lancaster, set the scene for handling single parents in that way when he told the London conference on crime culture that
single parent families and illegitimacy were to blame for rising crime and unemployment in inner cities.
Not only are those claims hurtful and insulting to single parents, but they are entirely untrue. A Home Office research study conducted in 1985 rebutted any link between single parents and crime.
The hon. Gentleman also sought to convince us that the children of single parents are more vulnerable to sexual abuse, although he tried to exclude certain categories. His remarks would be greatly resented by any single parent. I am sure that the hon. Gentleman does not have sufficient evidence to support them. If he is serious about helping young pregnant women, perhaps he should explain why the other night he voted against them having the right to early abortions and why, no doubt, he will be voting for a Bill that will lead to the closure of even more family planning clinics.
Single-parent families are not problem families but families with special problems, such as low incomes, poor housing and less access to employment. They are more affected by the Government's abysmal record on child care.
I challenge the Government's claim that there was ever some golden age of the family. If it existed in the 1960s, as the Prime Minister likes to tell us, why did the children of the 1960s reject it? A real family is what people define as real—what works for them. It is not something that the Prime Minister dreams up as she climbs another mountain of bigotry. Why is divorce bad for us when it was perfectly good for her and many members of the Cabinet?
The Government are seeking some new scapegoats and new victims. It is no coincidence that, on the same day as the Prime Minister told us that the increase in single parents was a threat to our whole way of life, the Secretary

of State for Social Security briefed journalists on his plans for pursuing absent fathers whom he said contributed only £155 million to the upkeep of their children while the Department of Social Security contributed £1.8 billion. The Secretary of State wants to cut benefits and excuse the poverty caused by his previous cuts of £79 billion from the benefits system since 1979.
The Opposition believe that parents should, of course, be responsible for their children, but when a young woman faces lone parenthood the last thing she wants is to be treated as a deviant and supervised in warden accommodation. That is a Dickensian solution to neanderthal thinking.
The Government have created massive poverty over the past decade. The changes in benefits in 1986 and 1987 created more problems for single parents. If the hon. Gentleman wants to help, he should seek to convince the Government that parenthood, not marriage, is the fundamental principle on which to base benefits for families with children. Many people have enormous problems that could be solved far more easily if they had a decent home. That is at the root of many of their problems.
The Bill is a disgrace. I shall vote against it, as I hope the House will.

Question put, pursuant to Standing Order No. 19 ( Motions for leave to bring in Bills and nomination of Select Committees at commencement of public business):—

The House divided: Ayes 84, Noes 144.

[Division No. 266]
[3.50 pm


AYES


Alexander, Richard
Holt, Richard


Alison, Rt Hon Michael
Howell, Ralph (North Norfolk)


Ashby, David
Hunter, Andrew


Bellingham, Henry
Irvine, Michael


Bennett, Nicholas (Pembroke)
Johnson Smith, Sir Geoffrey


Blackburn, Dr John G.
Jones, Gwilym (Cardiff N)


Body, Sir Richard
Kellett-Bowman, Dame Elaine


Bonsor, Sir Nicholas
Kilfedder, James


Boswell, Tim
Lloyd, Sir Ian (Havant)


Bowden, Gerald (Dulwich)
Macfarlane, Sir Neil


Braine, Rt Hon Sir Bernard
Marland, Paul


Brazier, Julian
Maxwell-Hyslop, Robin


Brown, Michael (Brigg &amp; Cl't's)
Mitchell, Andrew (Gedling)


Buck, Sir Antony
Moate, Roger


Burns, Simon
Monro, Sir Hector


Butcher, John
Montgomery, Sir Fergus


Butler, Chris
Morrison, Sir Charles


Carlisle, John, (Luton N)
Nicholson, David (Taunton)


Channon, Rt Hon Paul
Nicholson, Emma (Devon West)


Clark, Sir W. (Croydon S)
Onslow, Rt Hon Cranley


Coombs, Simon (Swindon)
Pawsey, James


Davies, Q. (Stamf'd &amp; Spald'g)
Porter, David (Waveney)


Day, Stephen
Raison, Rt Hon Timothy


Devlin, Tim
Shaw, Sir Giles (Pudsey)


Dover, Den
Shelton, Sir William


Evans, David (Welwyn Hatf'd)
Shepherd, Richard (Aldridge)


Fox, Sir Marcus
Sims, Roger


French, Douglas
Skeet, Sir Trevor


Gale, Roger
Smith, Sir Dudley (Warwick)


Gill, Christopher
Soames, Hon Nicholas


Glyn, Dr Sir Alan
Stewart, Allan (Eastwood)


Goodhart, Sir Philip
Stokes, Sir John


Gow, Ian
Stradling Thomas, Sir John


Greenway, Harry (Ealing N)
Temple-Morris, Peter


Greenway, John (Ryedale)
Thompson, D. (Calder Valley)


Hague, William
Thompson, Patrick (Norwich N)


Hargreaves, A. (B'ham H'll Gr')
Trotter, Neville


Hargreaves, Ken (Hyndburn)
Walker, Bill (T'side North)


Hayes, Jerry
Warren, Kenneth


Hayward, Robert
Widdecombe, Ann


Hicks, Mrs Maureen (Wolv' NE)
Wilshire, David






Winterton, Mrs Ann
Tellers for the Ayes:


Woodcock, Dr. Mike
Mr. David Shaw and



Mr. Roger Knapman.

Question accordingly negatived.

National Health Service and Community Care Bill (Allocation of Time)

The Secretary of State for Health (Mr. Kenneth Clarke): I beg to move,
That the Order of the House [14th March] be supplemented as follows:—

Lords Amendments

1. The proceedings on Consideration of Lords Amendments shall be completed at this day's sitting and, subject to the provisions of the Order of 14th March, if not previously brought to a conclusion, shall be brought to a conclusion eight hours after the commencement of proceedings on this Order.

2.—(1) For the purpose of bringing any proceedings to a conclusion in accordance with paragraph 1 above—

(a) Mr. Speaker shall first put forthwith any Question which has already been proposed from the Chair and not yet decided and, if that Question is for the amendment of a Lords Amendment, shall then put forthwith the Question on any further Amendment of the said Lords Amendment moved by a Minister of the Crown and on any Motion made by a Minister of the Crown, That this House doth agree or disagree with the Lords in the said Lords Amendment, or, as the case may be, in the said Lords Amendment as amended;
(b) Mr. Speaker shall then designate such of the remaining Lords Amendments as appear to him to involve questions of Privilege and shall—

(i) put forthwith the Question on any Amendment moved by a Minister of the Crown to a Lords Amendment and then put forthwith the Question on any Motion made by a Minister of the Crown, That this House doth agree or disagree with the Lords in their Amendment, or, as the case may be, in their Amendment as amended;
(ii) put forthwith the Question on any Motion moved by a Minister of the Crown, That this House doth disagree with the Lords in a Lords Amendment;
(iii) put forthwith with respect to the Amendments designated by Mr. Speaker which have not been disposed of the Question, That this House doth agree with the Lords in the said Amendments; and
(iv) put forthwith the Question, That this House doth agree with the Lords in all the remaining Lords Amendments;

(c) as soon as the House has agreed or disagreed with the Lords in any of their Amendments Mr. Speaker shall put forthwith a separate Question on any other Amendment moved by a Minister of the Crown relevant to that Lords Amendment.

(2) Proceedings under sub-paragraph (1) above shall not be interrupted under any Standing Order relating to the sittings of the House.

Stages subsequent to first Consideration of Lords Amendments

3. Mr. Speaker shall put forthwith the Question on any Motion made by a Minister of the Crown for the consideration forthwith of any further Message from the Lords on the Bill.

4. The proceedings on any such further Message from the Lords shall, if not previously brought to a conclusion one hour after the commencement of those proceedings.

5. For the purpose of bringing those proceedings to a conclusion—

(a) Mr. Speaker shall first put forthwith any Question which has already been proposed from the Chair and not yet decided, and shall then put forthwith the Question on any Motion made by a Minister of the Crown which is related to the Question already proposed from the Chair;


(b) Mr. Speaker shall then designate such of the remaining items in the Lords Message as appear to him to involve questions of Privilege and shall—


(i) put forthwith the Question on any Motion made by a Minister of the Crown on any item;
(ii) in the case of each remaining item designated by Mr. Speaker, put forthwith the Question, That this House doth agree with the Lords in their Proposal; and
(iii) put forthwith the Question, That this House doth agree with the Lords in all the remaining Lords Proposals.

Supplemental

6.—(1) Mr. Speaker shall put forthwith the Question on any Motion made by a Minister of the Crown for the appointment and quorum of a Committee to draw up Reasons.

(2) Such a Committee shall report before the conclusion of the sitting at which it is appointed.

7.—(1) In this paragraph "the proceedings" means proceedings on Consideration of Lords Amendments or on any further Message from the Lords on the Bill, on the appointment and quorum of a Committee to draw up Reasons and the Report of such a Committee.

(2) Paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the proceedings.

(3) No dilatory Motion with respect to, or in the course of, the proceedings shall be made except by a member of the Government, and the Question on any such Motion shall be put forthwith.

(4) If the proceedings are interrupted by a Motion for the Adjournment of the House under Standing Order No. 20 (Adjournment on specific and important matter that should have urgent consideration) a period equal to the duration of the proceedings on the Motion shall be added to the period at the end of which the proceedings are to be brought to a conclusion.

Mr. Gerald Kaufman: On a point of order, Mr. Speaker. I am sorry to interrupt these important proceedings, but I hope that you will understand that this is a matter directly related to your responsibilities and the rights of the House of Commons.
You will be aware, Mr. Speaker, that, following the European Community summit in Dublin yesterday, a declaration of 40 pages was issued by the Heads of Government. It anticipated that the Prime Minister would be making a statement about it tomorrow. Understandably a number of right hon. and hon. Members, including myself, have sought to obtain a copy of the document, and naturally we went first to the Library, which is always extremely helpful and forthcoming on these matters. We were given to understand that the document would not be available in the Library until tomorrow because the Foreign Office had refused to supply it, on the directions of 10 Downing street.
We made our own efforts to obtain a copy and have done so through the office of the European Communities. I understand that copies are now in the Library, because the Library told the Foreign Office that it would seek to obtain the document elsewhere if the Foreign Office did not supply it.
Clearly, if that is true, it is a deliberate attempt by the Prime Minister's office to withhold from Parliament material that would enable Members properly to interrogate the Prime Minister tomorrow. It would be wholly unacceptable if the Library, which provides a valuable service to all right hon. and hon. Members, whatever their party, were prevented from providing that service, and I should therefore be most grateful if you would look into the matter.

Mr. Speaker: That is not strictly a matter for me, but if the Library is prepared to produce these documents that is certainly a matter for the Library and for me. The provision of documents of this kind is a matter for the Government. I am sure that what the right hon. Gentleman has said will have been heard by the Leader of the House.

Mr. Clarke: The motion proposes eight hours of debate on the Bill. The House will share my pleasure at the fact that we can anticipate that by midnight we will have completed discussions on this most important Bill. We are approaching the stage where we are about to start on the important process of implementing the reforms that the Government sketched out some time ago in a White Paper.
Obviously, no Government introduce such a supplemental timetable motion lightly. Hon. Members will agree that it is helpful to have some limit on our debates so that they can be ordered and we can conclude our discussions at an acceptable hour.
I have attempted to discuss the timetabling through the usual channels. I will say nothing other than it is unfortunate that the hon. Member for Livingston (Mr. Cook) declined to discuss with me at all the basis on which we might proceed. That approach to parliamentary procedure shows that perhaps the hon. Gentleman expects to stay in opposition for rather longer than he publicly implies. Anyone contemplating government knows the importance of having discussions through the usual channels on matters of this kind. No doubt that follows from the way in which proceedings were conducted on Report. The House will remember that, after a comparatively peaceful and reasonable Committee stage, we suddenly had an all-night sitting on Report, with inordinately long debates on some amendments so that we covered only five amendments in nearly 18 hours.
In case anyone should argue that the Bill will not have had adequate consideration by midnight, I remind the House that in Committee the Bill received 109 hours of detailed consideration. More than 800 amendments were tabled, full discussion took place, and some amendments were made to the Bill. There was more detailed scrutiny in the other place where the Bill had eight days in Committee and four days on Report. More than 800 amendments were put before the other place and nearly 100 hours of further consideration took place there.
As a result, the Bill has quite correctly taken up an enormous amount of parliamentary time during the winter. I am told that the two Houses have given more consideration to the Bill than they did to, for example, the Water Act 1989 which we all remember was a Bill of equal political controversy. This one is even more important. In case it is argued that all that debate has led to inflexibility by the Government, I can tell the House that throughout the discussions we have responded to debate and made important amendments. I am told that in 24 policy areas substantive change has been made in response to parliamentary and other discussion.
Hon. Members may have noticed that 177 of the amendments before us are Government amendments introduced in another place. That sounds like a formidable amount of last-minute change, but it should not cause the House undue alarm because many of the amendments are drafting changes and almost without exception the others fulfil undertakings given by Ministers in response to pressure from hon. Members. Those not in response to


undertakings are the result of the Government's introducing new material which received a general welcome. I do not think that they are likely to give rise to controversy. For example, we are about to consider statutory consultation on the creation of national health service trusts.
We have incorporated provisions for a procedure on community care complaints, and the most important matter that we shall discuss in the time laid down by the motion is the fact that we have paved the way for a new clinical standards advisory group. On that I reached an important agreement with the presidents of the Royal Colleges of Medicine and the Royal Colleges of Nursing and the associated statutory bodies. I think that the climate in the health service has substantially improved since we reached that agreement with the leaders of the professions not only on the detail of the reforms, but on the need to make sure that we have a new mechanism which will keep under constant scrutiny the standards of clinical care given to patients. That falls within the remit of the debate.
Those are significant improvements. We have discussed almost all of them at great length on previous occasions and we shall properly give them a final eight hours of consideration today.
I believe that eight hours will give the House ample time to consider the amendments. There is not a great deal of genuine controversy on the amendment paper, although one important matter has been trailed which we shall undoubtedly reach later this evening. There is ample time to talk about ring fencing and other matters. There is little else that anyone will want to vote on or argue about. Therefore, I hope that the timetable motion is generally acceptable to the House.

Mr. Robin Cook: In opposing the timetable motion, may I say that the Secretary of State once again has shown his ineffable imperviousness to criticisms of his measure. During his address he was unwise enough to say that the agreement on clinical standards with the heads of the royal colleges demonstrated, if I remember his words correctly, the improved attitude within the health service to his reforms. Those royal colleges are precisely the same royal colleges which, in a unique document on which they achieved joint agreement, recorded their view that
there is no evidence that the changes overall will improve the standard of care, will improve access to care, will improve choice of care or will improve the cost-effectiveness of care.
That is the statement which the Secretary of State is desperately obliged to claim in support of the improved climate for his reforms.
The Secretary of State was good enough to make public the discussions that have taken place through the usual channels about whether there should be discussions about the timetable motion. Thereby he releases me from any obligation to maintain the confidentiality of the discussions. Therefore, I share with the House what I said to the Secretary of State's office. We refused to discuss tonight's timetable motion with the Secretary of State because throughout the Committee proceedings we discussed through the usual channels sensible arrangements for debating and timetabling the Bill. Those arrangements were in the interests of both the members of the Committee and the staff and patients of the health

service who thereby secured adequate debate on the matters of importance in the Bill. The Secretary of State knows full well why I now decline to enter into any such discussions. Our discussions with him on the procedure in Committee were misrepresented by him as agreement to the principle of the Bill.
I am interested that the Secretary of State now tells the House that an enormous amount of time has been spent on considering the Bill. It was only back in March that he told the British Medical Journal that he was impressed by the smooth and rapid progress of the Bill. At that stage there was no suggestion that the Bill required guillotining. On the contrary, he cited the speed with which the House disposed of the Bill as a sign that he was winning the arguments.
The Secretary of State suggested that his motion will be helpful to the House. In this regard, as in so many others, I beg to differ with the Secretary of State. On Monday night, when the messenger brought from the House of Lords the amendments that we are to debate this afternoon, he passed along a corridor which contains a series of paintings depicting the triumph of Parliament in the civil war—the triumph of the rights of the House over arbitrary government and the triumph of the freedom of the House to decide for itself what issues it will debate and vote on. If King Charles I were capable of putting his head back on and returning to the Chamber, he would be astonished at the powers that the present Administration exercise over the Commons.
The Prime Minister and the Patronage Secretary exercise powers over this House of which King Charles could only dream. As my hon. Friends will be aware, King Charles's misfortune was that he had to deal with a Parliament of free men, not pressed by party faction, bribed by patronage from No. 10 or cowed by the threat of a row from the hon. Member for Derby, North (Mr. Knight). It was a Parliament of Members who asserted the rights of this House for the people who sent them here.
The most remarkable feature of the proceedings is not that we are invited to dispose of 24 groups of amendments in seven hours after the debate on the timetable motion, which gives us just about one vote per group of amendments. We are used to the Government treating the House with contempt. This is the same ministerial team that on Report invited the House to dispose of 100 Government amendments in a single block vote, thus giving a wholly new context to the term "block vote." It is therefore no surprise that we should be faced with such a motion.
The real surprise would be if the Opposition were to find a single Conservative Member of Parliament voting with them tonight; it would be a surprise if any Government Back Bencher were prepared to vote for the rights of the House against the Government's proposals and had the courage to defend them without the protection of the guillotine.

Mr. Jerry Hayes: rose—

Mr. Cook: The hon. Member for Harlow (Mr. Hayes) is taking a close interest in the proceedings. Let me tell him about the extent to which Ministers assume that they can use him and his hon. Friends as rubber stamps. Let me outline the timetable for the rest of the week. Tomorrow the House of Lords expects to receive the results of our debate. The other place is expected to reach a conclusion


tomorrow. The press has been briefed to expect Royal Assent to the Bill on Friday. Tonight the House of Commons is faced with considering 187 amendments—but, no matter, the press has been confidently told that in 48 hours the Bill will become law. That is the real reason for the timetable motion; that is why the House has to consider the amendments and reach a conclusion by midnight. It is not because the Secretary of State is afraid that he will turn into a pumpkin and be towed away by 12 white mice at midnight, nor is it because he is frightened that I might warm to my theme, get carried away by the points that I want to make and speak for another two hours during the proceedings.
The reason why the Government have to get the proceedings concluded by midnight is that they have to get the measure back to the House of Lords before it rises tonight. The reason for guillotining our proceedings on the amendments passed by their Lordships is solely to allow their Lordships to go to bed at midnight.

Mr. Hayes: rose—

Mr. Cook: If the hon. Gentleman wishes to intervene, I shall be happy to allow him to do so. If he does not, I shall not give way to him.

Mr. Hayes: I am amazed to hear the hon. Gentleman talk about block votes with the eloquence of Satan denouncing sin. We have debated the Bill at considerable length. There were tremendous contributions from both sides, particularly the Government side, in Committee. That is most unusual. [Interruption.] Yes, it is most unusual. It has made this measure much better than other measures that we have considered in the past. It has been properly debated and discussed. There is not a great deal to argue about. There will be a few little skirmishes on ring fencing, but the fact is that the overwhelming majority of the Bill has been accepted by Conservative Members and by the medical profession.
The hon. Gentleman did his best in Committee with a fairly weak case. However, most of the arguments were put forward by my hon. Friends. Nothing much happened on the Opposition side. Therefore, they felt so horrendously guilty about it that they had to keep us up all night to show their trade union friends that they were doing something. Now we are having this nonsensical debate. The hon. Gentleman did not consult my right hon. and learned Friend the Secretary of State for Health about the guillotine motion because he had not thought out his arguments on it. Judging by his speech, he has not even yet made up his mind.

Mr. Cook: I hope that the hon. Gentleman's intervention will at least have served the purpose of sparing the House yet another speech from the hon. Gentleman. I must, however, take up one point that he made during that stream of consciousness. Some of my hon. Friends will have noted it; it is thoroughly revealing of the difficulty that faces us in getting the Administration to believe that there are people in this country who oppose the measure. The hon. Gentleman said that the medical profession now accept the proposals.

Mr. Hayes: Eighty per cent. of them do.

Mr. Cook: Only today, at the British Medical Association conference, another major campaign was launched by the medical profession against the very matters that we are discussing. Does any Conservative Member ever listen to anything that is said by people outside this Chamber?
One can confidently predict that, as a result of the motion, a number of Lords amendments will not be debated. For instance, Lords amendments Nos. 111 to 114 are the third last group on the selection list. They have not a hope of being reached. They are, Mr. Speaker, among the amendments that you will almost certainly be called upon to put to the House forthwith at midnight. The House will then have to vote on those amendments, along with all the other outstanding amendments—in one single vote. We shall not only not debate them; we shall not vote upon them separately.
Lords amendments Nos. 111 to 114 provide that at least one member of a health authority shall represent the universities and teaching schools in that authority's area. The Secretary of State will be aware that the Opposition have tabled an amendment to build on that precedent and to require that one other member of the health authority should also be a member of the local authority for that district or region. It tackles one of the greatest perversities of the Bill, which purports to expand services to the community while at the same time booting off the health authorities the last remaining representatives of the very councils that provide those services in the community.
We want to hear from the Secretary of State whom he intends to put on the health authorities in their place. Will the new representatives be like the new chair of South-West regional health authority, who celebrated his recent appointment by writing to every member of the staff telling them that he has a lot to learn about what the NHS does and offering a holiday for two in Amsterdam for the best explanation in 50 words? The people whom we want to serve on health authorities are people who know more than can be said in 50 words about the business of the NHS. We want people who are committed to keeping the NHS a public service. I warn the Secretary of State that if, this autumn, he does not appoint such people to the health authorities, the Labour Government, when they come to power, will not be bound by those appointments.
Lords amendment No. 111 raises matters of controversy on the Labour Benches. But, in fairness to the Secretary of State, I remind the House that some of the measures before us tonight apparently are matters of controversy on the Treasury Bench. I was dumbfounded—almost struck dumb—by his claim that there are few items of genuine controversy before us tonight. We have before us tonight no fewer than five Government motions to disagree with Lords amendments.
The most perverse of those would strike out the ring fencing of community care required in Lords amendment No. 70. The House will certainly regard that as a matter of major controversy. I should point out, therefore, that the motion that we are invited to pass tonight prescribes that if we disagree with the Lords on that amendment and send it back to be debated tomorrow and if tomorrow the Lords decline to be persuaded by our disagreement and send it back to us, we shall have precisely one hour in which to dispose of that second message from the Lords and any other message that we may receive from them.
The Secretary of State can be forgiven for wanting to get that debate over quickly. After all, it concerns an issue


on which he stands entirely alone. Sir Roy Griffiths recommended ring fencing and the Select Committee concluded unanimously in favour of ring fencing. Every voluntary organisation that has commented on it has supported ring fencing, and 97 per cent. of directors of social services have demanded ring fencing. Even the proprietors of private residential care homes are terrified that the local authorities will not have the resources that they will require if there is no ring fencing.
Yet now, at this late stage in our proceedings on the Bill, we once again find the Secretary of State standing alone, convinced that everybody but him is wrong. Such defiance of all informed opinion gives the Secretary of State a heroic stature. He stands alone upon a peak in Richmond terrace. Like stout Cortez, he probably stands in silence, too, because I can make one prediction with confidence: if the timetable motion is passed, we shall not have time to debate all five Government motions to disagree with the Lords amendments.

Mr. Andrew Rowe: I am sure that it has not escaped the hon. Gentleman's attention that, when stout Cortez stood silent on that peak, he had conquered the terrain on which he stood.

Mr. Cook: I am most grateful to the hon. Gentleman for convincing the House that at least one other hon. Member has read Keats.
As I was about to say, if the motion is passed, the House will certainly not debate all five Government motions. At midnight, Back-Bench Members will be invited to vote down the relevant Lords amendments without even hearing why the Government want them to do that. After that is over, my hon. Friends and I will go on a reasons committee to approve the reasons why the House disagrees with the Lords amendments. That will probably be the first time that any hon. Member hears what those reasons are.

Mr. Kenneth Clarke: Does the hon. Gentleman agree that, while he is sounding indignant about constitutional impropriety, he appears to be working to ensure that we do not actually discuss the Lords amendments, because he has taken a quarter of an hour out of the allotted eight hours expostulating rage about the inadequacy of time? When the hon. Gentleman concludes his remarks, we will embark on a debate on consultation on NHS trusts, on which subject he used five and a half hours on Report, when he first got into the macho "Let's liven it up" opposition that he did not previously display. Will the hon. Gentleman please allow us to get on to the substance of the issue rather than go over old ground again?

Mr. Cook: The Secretary of State helpfully brings me to my next point. He is perfectly correct. The first amendment is a grudging concession to my two-hour speech on Report, because, at long last, it would write into the Bill a requirement that regional health authorities must consult on opt-out proposals. That is welcome as far as it goes. The problem is that, although it obliges the regions to consult, it does not oblige the Secretary of State to pay any attention to the results of those consultations. Why? It is because every ballot and every opinion poll on this matter has shown that the right hon. and learned Gentleman cannot sell the idea that patients will get a better health service if local hospitals go it alone. The Secretary of State

will never persuade the people who need the health service that a more commercial health service will be a more caring health service.
The Secretary of State knows that my hon. Friends and I have tabled a modest amendment that will require him not to make an order for opt-out unless the consultation for which the Bill provides reveals substantial support for opt-out.
My hon. Friend the Member for Peckham (Ms. Harman) has a fine speech ready on the issue. She has been working on it for the three months since the Bill was considered on Report. I shall startle my hon. Friend by saying that I am willing to forgo hearing her speech. I am even willing to forgo the exquisite entertainment of hearing the Secretary of State explain how he can square an order for consultation with freedom for him not to be bound by that consultation. I shall forgo all that and offer the Secretary of State a deal. We will drop our amendment if he will drop his five motions to disagree with the Lords amendments. If he does that, we can conclude the business inside two hours flat, and we could all go off to dinner. To tempt the Secretary of State, let me say that I shall buy the beer. The right hon. and learned Gentleman cannot say, "You will vote down the five Lords amendments, and you will finish that by midnight." I note the wider irony of our proceedings. I cannot resist it.

Mr. Nicholas Bennett: Will the hon. Gentleman give way?

Mr. Cook: I would probably be out of order, Mr. Speaker, if I made a speech without giving way to the hon. Gentleman.

Mr. Bennett: So that the nation and the House may get the hon. Gentleman's indignation into some perspective, is he any relation to the Mr. R. Cook who represented Edinburgh, Central and voted five times on 20 July 1976 to guillotine five separate Bills?

Mr. Cook: Yes, I plead guilty to that charge. As the hon. Gentleman has raised that point—it is not a wildly original point as it has been made in every guillotine debate of this Session—I shall make three points in response. I voted for the five guillotine motions on measures that were all in the manifesto and electoral address on which I stood. We are debating a motion on a Bill of which there was not a hint in the manifesto or electoral address on which the hon. Member for Pembroke (Mr. Bennett) stood. Secondly, the 1974–79 Parliament approved 11 motions to guillotine 11 Bills, but since 1987 the Government have guillotined 12 Bills. Thirdly, if the hon. Gentleman checks, he will find that those guillotine motions did not apply to Lords amendments. There were no guillotine motions on Lords amendments until 1983, under the Administration which he purports to support.

Mr. Paul Flynn: The score is three-nil.

Mr. Cook: As my hon. Friend says, a rugby score.
There is a wider irony about our proceedings tonight. The haste of our proceedings in the House this week conflicts with the collapse of the Secretary of State's timetable for his reforms in the world outside, where all his bluster cannot drown the noise of squealing brakes. When the Secretary of State produced the White Paper, we were told that by April health managers would be shopping round Britain for the best buy in, to use one of his


favourite phrases, an all-singing, all-dancing internal market. Those same health managers have been firmly told that in April they must stick so closely to existing referral patterns that no one will notice that anything has changed. The problem with the Secretary of State is not that he cannot get his reforms to work by April but that the Prime Minister is terrified that he might get them to work before the next general election.
Here I come to the appropriate final thought for the debate, which puts in context the motion to curtail our democratic rights. As the Bill ends its passage through Parliament, it is even more unpopular with the public than when it began. When the Prime Minister launched on "Panorama" the review that led to the Bill, she said:
When we are ready, we shall come forward with our proposals for consultation. Should they meet with what people want, we will then translate them into legislation.
I must have nodded off through the consultation period.
The proposals in the Bill certainly do not meet what people want. The Bill has never been opposed by fewer than four votes to one in every opinion poll. Tonight, the Secretary of State will get his motion; he will get his Bill by midnight; and he will get Royal Assent on Friday. But then his troubles start because the debate leaves this place, the one place in Britain where he can find a majority for his proposals, and goes out into the country, where it has lost in every ballot that has been held. There will be no guillotine motion to protect the right hon. and learned Gentleman, no Whips to dragoon the voters and not even the hon. Member for Pembroke to egg him on with helpful reflections from Hansard. There will be only him and us. We shall pursue him around the country. We shall treat every consultation on opt-out as though it were a by-election. We shall hang the reforms round the necks of himself and his colleagues.
It is fitting that the Bill ends its proceedings with this squalid motion because it was introduced without any democratic mandate. The electorate, who were denied an opportunity to express a view at the last general election, will take their revenge at the next general election, not just to put the right hon. and learned Gentleman into opposition but to vote for a publicly funded, publicly managed health service run by local people accountable to local communities. That is the health service we believe in, and that is the health service that we shall create after this Bill is repealed.

Mr. Jack Ashley: I was surprised by the disingenuous way in which the Secretary of State introduced the motion. He said that the House will be pleased to have completed discussion on the Bill by midnight. He knows quite well that Labour Members are anything but pleased about completing discussion by midnight. We want to have full and proper discussion.
The Secretary of State was wrong when he said that there had been what he called more detailed scrutiny in the House of Lords. The point is that the guillotine motion will not allow us to discuss the House of Lords amendments fully. That is what is wrong with the motion. By refusing to allow us to discuss these important amendments properly, he is insulting members of the House of Lords and he is guilty of failing to allow this House full and proper discussion of crucial amendments.
The major issues in the Bill are about both health services and community care. I have no doubt what will be sacrificed by the guillotine. Health services are important and have the backing of pressure groups, the royal colleges and, not least, the suffering patients, but on the whole the Government neglect community care. Certainly we shall not have an adequate opportunity to discuss that aspect.
The Secretary of State is failing to ensure that the 6 million people—according to the Office of Population Censuses and Surveys—who need community care receive proper consideration in the House. There are many disabled people and many more millions of old people who live alone or are looked after by relatives who themselves may be disabled or old. They will not be given the consideration that we should give them. I hope that, within the limited confines of the debate, we shall be able to have adequate discussions about disabled and old people who need community care.
We shall probably discuss the important issue of ring fencing. I remind the Secretary of State that, on the general timetable, it is illuminating to remember the build-up to the Bill. In March 1988, Sir Roy Griffiths published his report on community care. Twenty months later, after a great deal of pressure, the Government introduced their proposals in the White Paper. Only one week later, the Minister introduced the Bill. It is outrageous to rush these matters without proper discussion. The same is happening again tonight.
This is an enabling Bill and will give local authorities the opportunity to act in certain ways to help disabled people through community care. If the provision is poor, as it will be, the Secretary of State will be able to blame local authorities rather than the Government. That is the clever twist in the Government's handling of the Bill. The Secretary of State may say, "There they go, those terrible local authorities, falling down on the job, and here am I, a concerned Secretary of State anxious to help, but I cannot control the town halls," while not giving them enough money, denuding them of resources and denying them the cash to look after disabled people and old people. That is the trick that he will play. He will not even allow us to discuss those issues tonight. That is deplorable.
I have heard a rumour—it is only a rumour—that the Government intend to overturn the Lords amendments which ensure that people who run homes for those with a mental handicap must declare criminal convictions. If it is true, it is shocking. The idea that Ministers can allow crooks, thieves and possibly sexual molesters to take charge of those homes without declaring their criminal background is outrageous.
The Government, understandably, provide care for children. They say that they regard the welfare of children as important. But what about the welfare of mentally handicapped people? Their welfare will go by the board if the Government oppose that Lords amendment. What discussions will we be able to have about that? The Secretary of State referred to all the hours that we have devoted to the Bill including all those hours in Committee, but we will not be able to deal with the Lords amendments which will deny something that is very important—[Interruption.] The Secretary of State is not listening because he is enjoying a conversation with the Minister for Health.

Mr. Kenneth Clarke: I am listening.

Mr. Ashley: I am glad. I would enjoy a conversation with the Minister for Health. She is a marvellous conversationalist and wonderful to talk to. However, I listen to the debates and I would appreciate it if the Secretary of State would listen to my point about the overturning of Lords amendments.
The Lords amendments are of great value. I was referring to the Lords amendments that will deal with people who run homes for the mentally handicapped. If the people running those homes have crooked backgrounds, we should know about that. We are entitled to know. It would be wrong of the Government to hide that information from us and it would also be damaging for the mentally handicapped. I hope that the Secretary of State will think again.
I have about 5,000 other points that I should like to have made, but I will not because I am aware of your eye on the clock, Madam Deputy Speaker. The Secretary of State is anxious to get on to the subject matter. We are also anxious to do that.
The Secretary of State does his homework and he works very hard. No doubt he has read the report of the debates in another place. Although he will not agree with me, I believe that the Lords made substantial points. They won their amendments by reasoned arguments, not by wild rhetoric or banging a drum. They were seeking to provide community care for the disabled and for old people. It will be a matter of great regret if those amendments are thrown out. It would be a scandal if they were thrown out without any discussion. I ask the Secretary of State to allow us more time to discuss those amendments.

Mr. Charles Kennedy: I want to detain the House for a few moments with a specific practical problem that arises from the timetable motion. I hope that the House will reject the motion, for the reasons outlined by the hon. Member for Livingston (Mr. Cook). He referred to two groups of amendments that we will not reach and on which we will have no proper discussion. Those groups are amendments Nos. 111 to 115 in schedule 1 and the equivalent set for Scotland, amendments Nos. 118 to 122.
I object to the timetable motion in principle, and I will also oppose it because it is extremely important that we discuss the amendments to which I have referred as there were further developments in another place earlier this week. The substance of the Bill was changed at 1 am on Tuesday morning in the other place.
The position of universities in England and Wales and in Scotland have changed. I hoped that the Secretary of State for Wales would be able to say something about that tonight, because that was a significant change. As a result, the universities in England and Wales and those in Scotland have moved out of step with regard to the Health Service. One of the few useful things that the Bill offered was an opportunity to bring those universities back into step, because they have been out of phase on and off for the past 15 years.
We referred in Committee to the universities' position in the wider context of the relationship between the universities and the health service. The amendments in schedules 1 and 2 to which I have referred were tabled by Lady Young and accepted by the Government on Report in the Lords. I believe that there was cross-party support

for the arguments in Committee. That was clear from the way in which Lady Young moved the amendments in the House of Lords and also from the way in which the Government accepted them.
According to the amendments, universities have a duty to consult about appointments. It seems to me that, if the purpose of the amendments is to secure effective joint management, that consultation must take place. If that were to happen in Scotland, appointments in England and Wales would be brought into line with the present practice.
The position between universities in England and Wales and those in Scotland has been different in the principal Acts—the National Health Service Act 1977 and the National Health Service (Scotland) Act 1978. As a result of amendment No. 134, which was accepted by the Government earlier this week in another place, there is now a statutory duty to include appointments to the Scottish health boards from universities with medical and dental schools, as happens with regional and district authorities in England and Wales. In addition, however, there is a statutory duty under schedule 1 to the 1978 Act to consult the universities in Scotland about those appointments. My amendments would tidy up that position which exists as a result of the amendment that was accepted earlier in the week.
As we have a national system of education and a national health service—I read with interest the France report, in the name of the permanent secretary at the Department of Health, which appeared last week and which is signed by the Secretary of State for Health and the Secretary of State for Education and Science—it seems sensible that we should have a proper United Kingdom basis for that uniformity. It is disappointing that this timetable motion will prevent us from discussing that point. I should appreciate any clarification from the Secretary of State about my points.

The Minister for Health (Mrs. Virginia Bottomley): In supporting the timetable motion, I must stress most strongly that this Bill has been thoroughly and rigorously scrutinised at great length already. It has spent 146 hours in this place, and 92 hours in the other place, and more than 2,000 amendments have been tabled to it. As my right hon. and learned Friend the Secretary of State has said, significant changes have been made to 24 areas of the Bill. No one can seriously claim that the Bill has been railroaded through. On the contrary, it has been thoroughly tested and significantly improved.
Yes, Conservative Members are in a hurry. We want to see the benefits of this legislation. We do not want to delay unduly. Six and a half months have passed since Second Reading, and during that time every aspect of the Bill has been rigorously and thoroughly scrutinised and debated.
I must reiterate the point made by my right hon. and learned Friend. All but five of the 182 amendments are either technical drafting changes or positive concessions made by the Government. My right hon. and learned Friend has already referred to the important clinical standards advisory group, which is an important further addition to our reforms. He also referred to the community care complaints procedures which we accepted as a result of discussions in Committee. There will also be statutory consultation on NHS trusts.
Further improvements and developments have occurred as a result of careful debate and scrutiny. There will be consultations with carers' and users' organisations on community care plans. This is the first time that the interests of carers and users have been enshrined in legislation. The Bill also removes any doubt about the ability of local authorities to provide emergency treatment, and that is in recognition of an important point made by the hon. Member for Livingston (Mr. Cook).

Mr. Tom Clarke: I hope that I do not sound churlish, but the Minister said that this is the first time that the needs of carers have been embraced in legislation. Does that represent a total dismissal of the Disabled Persons (Services, Consultation and Representation) Act 1986?

Mrs. Bottomley: The hon. Gentleman knows very well that I take a serious and detailed interest in the 1986 Act and recognise the important contribution that it has made in this area. However, the Bill provides a new framework for care in the community for the elderly, the frail, the vulnerable, the mentally ill and the mentally handicapped. It will establish a new framework of care for the next decade and beyond. For the first time, we shall have a rational system with community care plans, opportunities for proper assessment and a complaints procedure. We shall be able to ensure that the vast resources that are already spent on care in the community are spent rationally and effectively.

Dame Elaine Kellett-Bowman: All that my hon. Friend has said is undoubtedly true, but it does not necessarily preclude ring fencing.

Mrs. Bottomley: My hon. Friend is drawing me into what will doubtless be the subject of a lengthy debate later in the evening.
It is clear, however, that local authority social services departments have more than held their own in relation to other spending departments in local government. They have increased their spending by 37 per cent. If my hon. Friend essentially distrusts local government—

Dame Elaine Kellett-Bowman: I do.

Mrs. Bottomley: That is sad.
For many years local authorities have bemoaned the fact that the Government have insufficient confidence in them. However, we have confidence that they can undertake these important new tasks. Ring fencing would not mean a single penny more of additional resources. The role of ring fencing and specific grants lies in areas which have been neglected and which need special leverage. Examples include the mental illness specific grant, and the resources that have been devoted to AIDS. My hon. Friend will note the new proposition for ring fencing the money for those with drug and alcohol problems. Those matters were referred to several times in Committee. However, ring fencing the entire resources for care in the community would seriously undermine the role of local government.
I refer my hon. Friend to the remarks made by my hon. Friend the Member for Mid-Kent (Mr. Rowe) on several occasions, when he said that ring fencing tends to lead to a reactionary, fossilised and backward-looking attitude to

those provisions. We want innovation and the development of appropriate services for care in the community that will need modern needs, on the basis of careful planning and rigorous scrutiny.
There has also been further recognition of the role of universities as members of the health authorities, and protection and enhancement of medical research and education in NHS trusts. That is an important further development. I do not accept what the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) said about the necessity for precisely the same mechanism in Scotland as in the rest of the country. His amendment might lead to individuals who are not from the locality of the authority becoming members of it. However, I appreciate his point and can reassure him that, when appointments are made to the authorities, a number of considerations will be borne in mind. Association with the district or region is obviously an important consideration.
The hon. Member for Livingston made the most outrageous allegations about those who are being appointed to serve on health authorities.

Mr. Kennedy: I am grateful to the Minister for giving way and do not want to delay her on this point. Although, unfortunately, I do not have the specific wording to hand, I am sure that her Department has made it clear that the intention behind the Government's thinking on that matter is to use people from the locality. The Minister's response did not seem to make such a strong commitment. If that is the Government's intention, why not include it in the Bill? There is anxiety that someone from one part of the country may be appointed to serve on a board in another part of the country, without necessarily having any grasp of the educational or health implications for that area.

Mrs. Bottomley: I refer the hon. Gentleman to the example of Salford, where there are teaching hospitals which will have a university member but where the medical school lies outside the district boundary. That is an example of a case that would be confined by the hon. Gentleman's amendment and where we could not achieve the end that we are seeking.
The issues that have already been raised will be reconsidered later today and will follow from those raised in the other place. However, I must return to the outrageous allegations made by the hon. Member for Livingston about members of health authorities. I should like to know whether the hon. Gentleman feels that he can justify them—not at this moment but perhaps in a later debate.
Greenwich health authority, for example, has—what a surprise—chosen as its representatives on the district health authority three Labour party prospective parliamentary candidates. That reveals its view of the sort of people whom it wants to put on the health authority. One individual concerned has absolutely no connection with the area—[HON. MEMBERS: "What is wrong with that?"] Opposition members ask, "What is wrong with that?" What is wrong is that it is characteristic of the Opposition, who constantly treat the health service as a party political football. Patients and those who work for the health service are heartily sickened when they see Opposition Members treating every development and improvement in the service as something about which they can make mischief and exploit for party political capital.
The hon. Member for Livingston has said that he will treat every consultation on an NHS trust proposal as a by-election, but I must advise him that Conservative Members know exactly what we are trying to achieve in modifying the membership of the health authorities. We want effective committed individuals, with a businesslike approach, who realise that when one is running a service that is the largest employer not only in this country but in the whole of western Europe, and which is worth £29 billion, party political placemen from the Opposition are not what is wanted. We want those whom we can trust to discharge their responsibilities effectively, to continue making the improvements in health care that we have seen over the past decade, and who can continue to work under the guidance of and in liaison with my right hon. and learned Friend the Secretary of State, who has secured unprecedented resources for the health service and further improvements for the care of our people.

Mr. Robin Cook: I am grateful to the hon. Lady for drawing breath at that point. She has referred to the appointments made to the Greenwich health authority. Is she aware that one of the appointees is the leader of the Greenwich authority? He was elected to the authority and then elected leader of it. His appointment marks the sort of close relationship between the social services and the health authority that my hon. Friends and I welcome and wish happened more often in the country. However, if the Minister is taking that tack, will she explain how, in applying the criteria of businesslike, efficiency and commitment to the health service, it has just been concluded that the most appropriate chair for one of the Leeds health authorities is the chairman of the West Yorkshire Conservative Association?

Mrs. Bottomley: We are looking for those who have the ability to discharge their responsibilities effectively and constructively. A close working relationship between the health authorities and the local authorities can frequently play an important part in health provision. It is essential that there are close working agreements, especially for the care in the community proposals. However, those appointed are appointed because of the contribution that they can make to the health service, not so that they can represent avested interest or group.
I know that hon. Members want to make headway in debating the amendments at greater length. We are in haste to implement the reforms to ensure that the British people can benefit from an improved and more rationally run health service. Our care in the community proposals set a new framework for the next decade and beyond. Carers and users will be respected and recognised. My right hon. and learned Friend has included safeguards. Community care plans will be published and consulted on locally to ensure the good will of the local community in constructing proposals for the frail and the elderly.
Under this Government, more patients are being treated and we have more doctors, nurses and resources. Fundamental to our proposals for reform is the fact that we want better management and more effective use of resources. Above all, we want the patient to be put first. I urge hon. Members to support the timetable motion.

Question put:—

The House divided: Ayes 305, Noes 200.

[Division No. 266]
[3.50 pm


AYES


Alexander, Richard
Holt, Richard


Alison, Rt Hon Michael
Howell, Ralph (North Norfolk)


Ashby, David
Hunter, Andrew


Bellingham, Henry
Irvine, Michael


Bennett, Nicholas (Pembroke)
Johnson Smith, Sir Geoffrey


Blackburn, Dr John G.
Jones, Gwilym (Cardiff N)


Body, Sir Richard
Kellett-Bowman, Dame Elaine


Bonsor, Sir Nicholas
Kilfedder, James


Boswell, Tim
Lloyd, Sir Ian (Havant)


Bowden, Gerald (Dulwich)
Macfarlane, Sir Neil


Braine, Rt Hon Sir Bernard
Marland, Paul


Brazier, Julian
Maxwell-Hyslop, Robin


Brown, Michael (Brigg &amp; Cl't's)
Mitchell, Andrew (Gedling)


Buck, Sir Antony
Moate, Roger


Burns, Simon
Monro, Sir Hector


Butcher, John
Montgomery, Sir Fergus


Butler, Chris
Morrison, Sir Charles


Carlisle, John, (Luton N)
Nicholson, David (Taunton)


Channon, Rt Hon Paul
Nicholson, Emma (Devon West)


Clark, Sir W. (Croydon S)
Onslow, Rt Hon Cranley


Coombs, Simon (Swindon)
Pawsey, James


Davies, Q. (Stamf'd &amp; Spald'g)
Porter, David (Waveney)


Day, Stephen
Raison, Rt Hon Timothy


Devlin, Tim
Shaw, Sir Giles (Pudsey)


Dover, Den
Shelton, Sir William


Evans, David (Welwyn Hatf'd)
Shepherd, Richard (Aldridge)


Fox, Sir Marcus
Sims, Roger


French, Douglas
Skeet, Sir Trevor


Gale, Roger
Smith, Sir Dudley (Warwick)


Gill, Christopher
Soames, Hon Nicholas


Glyn, Dr Sir Alan
Stewart, Allan (Eastwood)


Goodhart, Sir Philip
Stokes, Sir John


Gow, Ian
Stradling Thomas, Sir John


Greenway, Harry (Ealing N)
Temple-Morris, Peter


Greenway, John (Ryedale)
Thompson, D. (Calder Valley)


Hague, William
Thompson, Patrick (Norwich N)


Hargreaves, A. (B'ham H'll Gr')
Trotter, Neville


Hargreaves, Ken (Hyndburn)
Walker, Bill (T'side North)


Hayes, Jerry
Warren, Kenneth


Hayward, Robert
Widdecombe, Ann


Hicks, Mrs Maureen (Wolv' NE)
Wilshire, David






Winterton, Mrs Ann
Tellers for the Ayes:


Woodcock, Dr. Mike
Mr. David Shaw and



Mr. Roger Knapman.




NOES


Allen, Graham
Hughes, Robert (Aberdeen N)


Alton, David
Illsley, Eric


Anderson, Donald
Ingram, Adam


Armstrong, Hilary
Johnston, Sir Russell


Ashdown, Rt Hon Paddy
Jones, Barry (Alyn &amp; Deeside)


Ashley, Rt Hon Jack
Jones, Ieuan (Ynys Môn)


Ashton, Joe
Jones, Martyn (Clwyd S W)


Banks, Tony (Newham NW)
Kaufman, Rt Hon Gerald


Barnes, Harry (Derbyshire NE)
Kennedy, Charles


Barnes, Mrs Rosie (Greenwich)
Kirkwood, Archy


Barron, Kevin
Lambie, David


Bell, Stuart
Leighton, Ron


Bennett, A. F. (D'nt'n &amp; R'dish)
Lewis, Terry


Bradley, Keith
Litherland, Robert


Brown, Nicholas (Newcastle E)
Livingstone, Ken


Bruce, Malcolm (Gordon)
Lloyd, Tony (Stretford)


Buchan, Norman
Loyden, Eddie


Buckley, George J.
McAvoy, Thomas


Caborn, Richard
McCartney, Ian


Callaghan, Jim
McNamara, Kevin


Campbell, Ron (Blyth Valley)
Madden, Max


Campbell-Savours, D. N.
Marek, Dr John


Canavan, Dennis
Marshall, Jim (Leicester S)


Carlile, Alex (Mont'g)
Martin, Michael J. (Springburn)


Carr, Michael
Martlew, Eric


Clark, Dr David (S Shields)
Maxton, John


Clarke, Tom (Monklands W)
Meale, Alan


Clay, Bob
Michael, Alun


Cohen, Harry
Michie, Bill (Sheffield Heeley)


Cook, Frank (Stockton N)
Michie, Mrs Ray (Arg'l &amp; Bute)


Cook, Robin (Livingston)
Morgan, Rhodri


Corbett, Robin
Morris, Rt Hon A. (W'shawe)


Cousins, Jim
Mowlam, Marjorie


Cox, Tom
Mullin, Chris


Crowther, Stan
Nellist, Dave


Cryer, Bob
Oakes, Rt Hon Gordon


Cummings, John
O'Brien, William


Dalyell, Tam
Orme, Rt Hon Stanley


Darling, Alistair
Parry, Robert


Davies, Ron (Caerphilly)
Pendry, Tom


Davis, Terry (B'ham Hodge H'l)
Pike, Peter L.


Dixon, Don
Powell, Ray (Ogmore)


Doran, Frank
Redmond, Martin


Dunnachie, Jimmy
Rees, Rt Hon Merlyn


Eastham, Ken
Reid, Dr John


Ewing, Harry (Falkirk E)
Ross, Ernie (Dundee W)


Ewing, Mrs Margaret (Moray)
Ruddock, Joan


Fatchett, Derek
Skinner, Dennis


Fearn, Ronald
Smith, C. (Isl'ton &amp; F'bury)


Field, Frank (Birkenhead)
Smith, Rt Hon J. (Monk'ds E)


Fields, Terry (L'pool B G'n)
Spearing, Nigel


Fisher, Mark
Steel, Rt Hon Sir David


Flannery, Martin
Steinberg, Gerry


Flynn, Paul
Stott, Roger


Foot, Rt Hon Michael
Strang, Gavin


Foster, Derek
Taylor, Mrs Ann (Dewsbury)


Garrett, Ted (Wallsend)
Thomas, Dr Dafydd Elis


Gilbert, Rt Hon Dr John
Thompson, Jack (Wansbeck)


Godman, Dr Norman A.
Turner, Dennis


Golding, Mrs Llin
Vaz, Keith


Griffiths, Nigel (Edinburgh S)
Wallace, James


Grocott, Bruce
Walley, Joan


Hardy, Peter
Watson, Mike (Glasgow, C)


Harman, Ms Harriet
Welsh, Andrew (Angus E)


Haynes, Frank
Welsh, Michael (Doncaster N)


Hinchliffe, David
Wigley, Dafydd


Hogg, N. (C'nauld &amp; Kilsyth)
Williams, Rt Hon Alan


Hood, Jimmy
Williams, Alan W. (Carm'then)


Howarth, George (Knowsley N)
Winnick, David


Howell, Rt Hon D. (S'heath)
Wise, Mrs Audrey


Howells, Geraint



Howells, Dr. Kim (Pontypridd)
Tellers for the Noes:


Hoyle, Doug
Mrs. Alice Mahon and


Hughes, John (Coventry NE)
Ms. Dawn Primarolo.

Division No. 267]
[4.58pm


AYES


Adley, Robert
Emery, Sir Peter


Aitken, Jonathan
Evans, David (Welwyn Hatf'd)


Alexander, Richard
Evennett, David


Alison, Rt Hon Michael
Fairbairn, Sir Nicholas


Allason, Rupert
Fallon, Michael


Amess, David
Favell, Tony


Arbuthnot, James
Fenner, Dame Peggy


Arnold, Jacques (Gravesham)
Field, Barry (Isle of Wight)


Arnold, Sir Thomas
Finsberg, Sir Geoffrey


Ashby, David
Fishburn, John Dudley


Atkins, Robert
Forman, Nigel


Atkinson, David
Forsyth, Michael (Stirling)


Baker, Rt Hon K. (Mole Valley)
Forth, Eric


Baker, Nicholas (Dorset N)
Franks, Cecil


Banks, Robert (Harrogate)
Freeman, Roger


Batiste, Spencer
French, Douglas


Bellingham, Henry
Gale, Roger


Bennett, Nicholas (Pembroke)
Gardiner, George


Benyon, W.
Garel-Jones, Tristan


Bevan, David Gilroy
Gill, Christopher


Biffen, Rt Hon John
Gilmour, Rt Hon Sir Ian


Blackburn, Dr John G.
Glyn, Dr Sir Alan


Blaker, Rt Hon Sir Peter
Goodhart, Sir Philip


Body, Sir Richard
Goodson-Wickes, Dr Charles


Bonsor, Sir Nicholas
Gorman, Mrs Teresa


Boscawen, Hon Robert
Gorst, John


Boswell, Tim
Gow, Ian


Bottomley, Peter
Grant, Sir Anthony (CambsSW)


Bottomley, Mrs Virginia
Greenway, Harry (Ealing N)


Bowden, A (Brighton K'pto'n)
Greenway, John (Ryedale)


Bowden, Gerald (Dulwich)
Gregory, Conal


Bowis, John
Griffiths, Sir Eldon (Bury St E')


Boyson, Rt Hon Dr Sir Rhodes
Griffiths, Peter (Portsmouth N)


Braine, Rt Hon Sir Bernard
Grylls, Michael


Brandon-Bravo, Martin
Gummer, Rt Hon John Selwyn


Brazier, Julian
Hague, William


Bright, Graham
Hampson, Dr Keith


Brown, Michael (Brigg &amp; Cl't's)
Hannam, John


Bruce, Ian (Dorset South)
Hargreaves, A. (B'ham H'll Gr')


Buchanan-Smith, Rt Hon Alick
Hargreaves, Ken (Hyndburn)


Buck, Sir Antony
Harris, David


Burns, Simon
Haselhurst, Alan


Burt, Alistair
Hayes, Jerry


Butcher, John
Hayward, Robert


Butler, Chris
Heathcoat-Amory, David


Carlisle, John, (Luton N)
Hicks, Mrs Maureen (Wolv' NE)


Carlisle, Kenneth (Lincoln)
Hicks, Robert (Cornwall SE)


Carrington, Matthew
Hill, James


Carttiss, Michael
Hind, Kenneth


Cash, William
Hogg, Hon Douglas (Gr'th'm)


Chalker, Rt Hon Mrs Lynda
Holt, Richard


Channon, Rt Hon Paul
Hordern, Sir Peter


Chapman, Sydney
Howard, Rt Hon Michael


Chope, Christopher
Howarth, Alan (Strat'd-on-A)


Clark, Dr Michael (Rochford)
Howarth, G. (Cannock &amp; B'wd)


Clark, Sir W. (Croydon S)
Howe, Rt Hon Sir Geoffrey


Clarke, Rt Hon K. (Rushcliffe)
Howell, Rt Hon David (G'dford)


Colvin, Michael
Howell, Ralph (North Norfolk)


Conway, Derek
Hughes, Robert G. (Harrow W)


Coombs, Anthony (Wyre F'rest)
Hunt, David (Wirral W)


Coombs, Simon (Swindon)
Hunt, Sir John (Ravensbourne)


Cope, Rt Hon John
Hunter, Andrew


Cormack, Patrick
Hurd, Rt Hon Douglas


Cran, James
Irvine, Michael


Critchley, Julian
Irving, Sir Charles


Davies, Q. (Stamf'd &amp; Spald'g)
Jack, Michael


Davis, David (Boothferry)
Janman, Tim


Day, Stephen
Jessel, Toby


Devlin, Tim
Johnson Smith, Sir Geoffrey


Dickens, Geoffrey
Jones, Robert B (Herts W)


Dicks, Terry
Jopling, Rt Hon Michael


Dorrell, Stephen
Kellett-Bowman, Dame Elaine


Douglas-Hamilton, Lord James
Key, Robert


Dover, Den
Kilfedder, James


Dunn, Bob
King, Roger (B'ham N'thfield)


Durant, Tony
Kirkhope, Timothy


Dykes, Hugh
Knapman, Roger






Knight, Greg (Derby North)
Ridsdale, Sir Julian


Knight, Dame Jill (Edgbaston)
Rifkind, Rt Hon Malcolm


Knowles, Michael
Roberts, Wyn (Conwy)


Knox, David
Roe, Mrs Marion


Lamont, Rt Hon Norman
Rost, Peter


Lang, Ian
Rowe, Andrew


Latham, Michael
Rumbold, Mrs Angela


Leigh, Edward (Gainsbor'gh)
Ryder, Richard


Lennox-Boyd, Hon Mark
Sackville, Hon Tom


Lester, Jim (Broxtowe)
Sainsbury, Hon Tim


Lightbown, David
Scott, Rt Hon Nicholas


Lilley, Peter
Shaw, David (Dover)


Lloyd, Sir Ian (Havant)
Shaw, Sir Giles (Pudsey)


Lord, Michael
Shaw, Sir Michael (Scarb')


Luce, Rt Hon Richard
Shelton, Sir William


Lyell, Rt Hon Sir Nicholas
Shephard, Mrs G. (Norfolk SW)


McCrindle, Robert
Shepherd, Colin (Hereford)


Macfarlane, Sir Neil
Shersby, Michael


MacKay, Andrew (E Berkshire)
Sims, Roger


Maclean, David
Skeet, Sir Trevor


McLoughlin, Patrick
Smith, Sir Dudley (Warwick)


McNair-Wilson, Sir Michael
Smith, Tim (Beaconsfield)


McNair-Wilson, Sir Patrick
Soames, Hon Nicholas


Madel, David
Speed, Keith


Major, Rt Hon John
Speller, Tony


Malins, Humfrey
Spicer, Sir Jim (Dorset W)


Mans, Keith
Spicer, Michael (S Worcs)


Maples, John
Squire, Robin


Marland, Paul
Stanbrook, Ivor


Marlow, Tony
Stanley, Rt Hon Sir John


Marshall, John (Hendon S)
Steen, Anthony


Marshall, Sir Michael (Arundel)
Stern, Michael


Martin, David (Portsmouth S)
Stevens, Lewis


Maude, Hon Francis
Stewart, Allan (Eastwood)


Maxwell-Hyslop, Robin
Stewart, Andy (Sherwood)


Mayhew, Rt Hon Sir Patrick
Stewart, Rt Hon Ian (Herts N)


Mellor, David
Stokes, Sir John


Miller, Sir Hal
Stradling Thomas, Sir John


Mills, Iain
Sumberg, David


Miscampbell, Norman
Summerson, Hugo


Mitchell, Andrew (Gedling)
Tapsell, Sir Peter


Mitchell, Sir David
Taylor, Ian (Esher)


Monro, Sir Hector
Taylor, John M (Solihull)


Montgomery, Sir Fergus
Taylor, Teddy (S'end E)


Moore, Rt Hon John
Tebbit, Rt Hon Norman


Morris, M (N'hampton S)
Temple-Morris, Peter


Morrison, Sir Charles
Thompson, D. (Calder Valley)


Moss, Malcolm
Thompson, Patrick (Norwich N)


Moynihan, Hon Colin
Thornton, Malcolm


Neale, Gerrard
Thurnham, Peter


Needham, Richard
Townsend, Cyril D. (B'heath)


Nelson, Anthony
Trotter, Neville


Neubert, Michael
Twinn, Dr Ian


Newton, Rt Hon Tony
Vaughan, Sir Gerard


Nicholls, Patrick
Viggers, Peter


Nicholson, David (Taunton)
Waddington, Rt Hon David


Nicholson, Emma (Devon West)
Walden, George


Norris, Steve
Walker, Bill (T'side North)


Onslow, Rt Hon Cranley
Ward, John


Oppenheim, Phillip
Wardle, Charles (Bexhill)


Page, Richard
Warren, Kenneth


Paice, James
Wells, Bowen


Parkinson, Rt Hon Cecil
Wheeler, Sir John


Patnick, Irvine
Whitney, Ray


Patten, Rt Hon John
Widdecombe, Ann


Pattie, Rt Hon Sir Geoffrey
Wiggin, Jerry


Pawsey, James
Wilshire, David


Peacock, Mrs Elizabeth
Winterton, Mrs Ann


Porter, Barry (Wirral S)
Winterton, Nicholas


Porter, David (Waveney)
Wolfson, Mark


Portillo, Michael
Woodcock, Dr. Mike


Powell, William (Corby)
Yeo, Tim


Price, Sir David
Young, Sir George (Acton)


Raison, Rt Hon Timothy



Rathbone, Tim
Tellers for the Ayes:


Redwood, John
Mr. Alastair Goodlad and


Rhodes James, Robert
Mr. Timothy Wood.


Ridley, Rt Hon Nicholas






NOES


Allen, Graham
Griffiths, Win (Bridgend)


Alton, David
Grocott, Bruce


Anderson, Donald
Hardy, Peter


Archer, Rt Hon Peter
Harman, Ms Harriet


Armstrong, Hilary
Heal, Mrs Sylvia


Ashdown, Rt Hon Paddy
Henderson, Doug


Ashley, Rt Hon Jack
Hinchliffe, David


Ashton, Joe
Hoey, Ms Kate (Vauxhall)


Banks, Tony (Newham NW)
Hogg, N. (C'nauld &amp; Kilsyth)


Barnes, Harry (Derbyshire NE)
Hood, Jimmy


Barnes, Mrs Rosie (Greenwich)
Howarth, George (Knowsley N)


Barron, Kevin
Howell, Rt Hon D. (S'heath)


Bell, Stuart
Howells, Geraint


Benn, Rt Hon Tony
Howells, Dr. Kim (Pontypridd)


Bennett, A. F. (D'nt'n &amp; R'dish)
Hoyle, Doug


Bidwell, Sydney
Hughes, John (Coventry NE)


Blair, Tony
Hughes, Robert (Aberdeen N)


Boateng, Paul
Hughes, Simon (Southwark)


Boyes, Roland
Illsley, Eric


Bradley, Keith
Ingram, Adam


Brown, Nicholas (Newcastle E)
Jones, Barry (Alyn &amp; Deeside)


Brown, Ron (Edinburgh Leith)
Jones, Ieuan (Ynys Môn)


Bruce, Malcolm (Gordon)
Jones, Martyn (Clwyd S W)


Buchan, Norman
Kaufman, Rt Hon Gerald


Buckley, George J.
Kennedy, Charles


Caborn, Richard
Kirkwood, Archy


Callaghan, Jim
Lambie, David


Campbell, Ron (Blyth Valley)
Lamond, James


Campbell-Savours, D. N.
Leadbitter, Ted


Canavan, Dennis
Leighton, Ron


Clark, Dr David (S Shields)
Lewis, Terry


Clarke, Tom (Monklands W)
Litherland, Robert


Clay, Bob
Livingstone, Ken


Clwyd, Mrs Ann
Lloyd, Tony (Stretford)


Cohen, Harry
Lofthouse, Geoffrey


Coleman, Donald
Loyden, Eddie


Cook, Frank (Stockton N)
McAllion, John


Cook, Robin (Livingston)
McAvoy, Thomas


Corbett, Robin
Macdonald, Calum A.


Cousins, Jim
McKelvey, William


Cox, Tom
McNamara, Kevin


Crowther, Stan
Madden, Max


Cryer, Bob
Maginnis, Ken


Cummings, John
Mahon, Mrs Alice


Cunliffe, Lawrence
Marek, Dr John


Cunningham, Dr John
Marshall, Jim (Leicester S)


Dalyell, Tam
Martin, Michael J. (Springburn)


Darling, Alistair
Martlew, Eric


Davies, Ron (Caerphilly)
Maxton, John


Davis, Terry (B'ham Hodge H'I)
Meale, Alan


Dewar, Donald
Michael, Alun


Dixon, Don
Michie, Bill (Sheffield Heeley)


Dobson, Frank
Michie, Mrs Ray (Arg'l &amp; Bute)


Doran, Frank
Mitchell, Austin (G't Grimsby)


Douglas, Dick
Molyneaux, Rt Hon James


Duffy, A. E. P.
Moonie, Dr Lewis


Dunnachie, Jimmy
Morgan, Rhodri


Eastham, Ken
Morris, Rt Hon A. (W'shawe)


Ewing, Harry (Falkirk E)
Mowlam, Marjorie


Ewing, Mrs Margaret (Moray)
Mullin, Chris


Fatchett, Derek
Nellist, Dave


Faulds, Andrew
Oakes, Rt Hon Gordon


Fearn, Ronald
O'Brien, William


Field, Frank (Birkenhead)
O'Neill, Martin


Fields, Terry (L'pool B G'n)
Orme, Rt Hon Stanley


Fisher, Mark
Parry, Robert


Flannery, Martin
Patchett, Terry


Flynn, Paul
Pendry, Tom


Foot, Rt Hon Michael
Pike, Peter L.


Foster, Derek
Powell, Ray (Ogmore)


Foulkes, George
Primarolo, Dawn


Fraser, John
Quin, Ms Joyce


Garrett, Ted (Wallsend)
Redmond, Martin


Gilbert, Rt Hon Dr John
Rees, Rt Hon Merlyn


Godman, Dr Norman A.
Reid, Dr John


Golding, Mrs Llin
Robertson, George


Graham, Thomas
Rogers, Allan


Grant, Bernie (Tottenham)
Rooker, Jeff


Griffiths, Nigel (Edinburgh S)
Ross, Ernie (Dundee W)






Ross, William (Londonderry E)
Thompson, Jack (Wansbeck)


Rowlands, Ted
Trimble, David


Ruddock, Joan
Turner, Dennis


Salmond, Alex
Vaz, Keith


Sheerman, Barry
Wallace, James


Sheldon, Rt Hon Robert
Walley, Joan


Shore, Rt Hon Peter
Wareing, Robert N.


Sillars, Jim
Watson, Mike (Glasgow, C)


Skinner, Dennis
Welsh, Andrew (Angus E)


Smith, Andrew (Oxford E)
Welsh, Michael (Doncaster N)


Smith, C. (Isl'ton &amp; F'bury)
Wigley, Dafydd


Smith, Rt Hon J. (Monk'ds E)
Williams, Rt Hon Alan


Soley, Clive
Williams, Alan W. (Carm'then)


Spearing, Nigel
Wilson, Brian


Steel, Rt Hon Sir David
Winnick, David


Steinberg, Gerry
Wise, Mrs Audrey


Stott, Roger
Worthington, Tony


Strang, Gavin
Wray, Jimmy


Straw, Jack
Young, David (Bolton SE)


Taylor, Mrs Ann (Dewsbury)



Taylor, Rt Hon J. D. (S'ford)
Tellers for the Noes:


Taylor, Matthew (Truro)
Mr. Frank Haynes and


Thomas, Dr Dafydd Elis
Mr. Allen Adams.

Question accordingly agreed to.

Resolved,
That the Order of the House [14th March] be supplemented as follows:—

Lords Amendments

1. The proceedings on Consideration of Lords Amendments shall be completed at this day's sitting and, subject to the provisions of the Order of 14th March, if not previously brought to a conclusion, shall be brought to a conclusion eight hours after the commencement of proceedings on this Order.

2.—(1) For the purpose of bringing any proceedings to a conclusion in accordance with paragraph 1 above—

(a) Mr. Speaker shall first put forthwith any Question which has already been proposed from the Chair and not yet decided and, if that Question is for the amendment of a Lords Amendment, shall then put forthwith the Question on any further Amendment of the said Lords Amendment moved by a Minister of the Crown and on any Motion made by a Minister of the Crown, That this House doth agree or disagree with the Lords in the said Lords Amendment, or, as the case may be, in the said Lords Amendment as amended;
(b) Mr. Speaker shall then designate such of the remaining Lords Amendments as appear to him to involve questions of Privilege and shall—

(i) put forthwith the Question on any Amendment moved by a Minister of the Crown to a Lords Amendment and then put forthwith the Question on any Motion made by a Minister of the Crown, That this House doth agree or disagree with the Lords in their Amendment, or, as the case may be, in their Amendment as amended;
(ii) put forthwith the Question on any Motion moved by a Minister of the Crown, That this House doth disagree with the Lords in a Lords Amendment;
(iii) put forthwith with respect to the Amendments designated by Mr. Speaker

which have not been disposed of the Question, That this House doth agree with the Lords in the said Amendments; and
(iv) put forthwith the Question, That this House doth agree with the Lords in all the remaining Lords Amendments;

(c) as soon as the House has agreed or disagreed with the Lords in any of their Amendments Mr. Speaker shall put forthwith a separate Question on any other Amendment moved by a Minister of the Crown relevant to that Lords Amendment.

(2) Proceedings under sub-paragraph (1) above shall not be interrupted under any Standing Order relating to the sittings of the House.

Stages subsequent to first Consideration of Lords Amendments

3. Mr. Speaker shall put forthwith the Question on any Motion made by a Minister of the Crown for the consideration forthwith of any further Message from the Lords on the Bill.

4. The proceedings on any such further Message from the Lords shall, if not previously brought to a conclusion one hour after the commencement of those proceedings.

5. For the purpose of bringing those proceedings to a conclusion—

(a) Mr. Speaker shall first put forthwith any Question which has already been proposed from the Chair and not yet decided, and shall then put forthwith the Question on any Motion made by a Minister of the Crown which is related to the Question already proposed from the Chair;
(b) Mr. Speaker shall then designate such of the remaining items in the Lords Message as appear to him to involve questions of Privilege and shall—

(i) put forthwith the Question on any Motion made by a Minister of the Crown on any item;
(ii) in the case of each remaining item designated by Mr. Speaker, put forthwith the Question, That this House doth agree with the Lords in their Proposal; and
(iii) put forthwith the Question, That this House doth agree with the Lords in all the remaining Lords Proposals.

Supplemental

6.—(1) Mr. Speaker shall put forthwith the Question on any Motion made by a Minister of the Crown for the appointment and quorum of a Committee to draw up Reasons.

(2) Such a Committee shall report before the conclusion of the sitting at which it is appointed.

7.—(1) In this paragraph "the proceedings" means proceedings on Consideration of Lords Amendments or on any further Message from the Lords on the Bill, on the appointment and quorum of a Committee to draw up Reasons and the Report of such a Committee.

(2) Paragraph (1) of Standing Order No. 14 (Exempted business) shall apply to the proceedings.

(3) No dilatory Motion with respect to, or in the course of, the proceedings shall be made except by a member of the Government, and the Question on any such Motion shall be put forthwith.

(4) If the proceedings are interrupted by a Motion for the Adjournment of the House under Standing Order No. 20 (Adjournment on specific and important matter that should have urgent consideration) a period equal to the duration of the proceedings on the Motion shall be added to the period at the end of which the proceedings are to be brought to a conclusion.

Orders of the Day — National Health Service and Community Care Bill

Lords amendments considered.

[The following Reports of the Social Services Committee are relevant: Second Report, Session 1989–90, Community Care: Future funding of Private and Voluntary Residential Care ( House of Commons Paper No. 257); Third Report, Session 1989–90, Community Care: Funding for local authorities ( House of Commons Paper No. 277); Fifth Report, Session 1989–90, Community Care: Carers (House of Commons Paper No. 410); Sixth Report, Session 1989–90, Community Care: Choice for Service Users ( House of Commons Paper No. 444); and the Government's Reply to the Second Report of Session 1989–90 (Cm. 1100).]

Clause 5

NHS TRUSTS

Lords amendment: No. 1, in page 6, line 6, at beginning insert
Subject to subsection (1A) or, as the case may be, subsection (1 B) below

The Secretary of State for Health (Mr. Kenneth Clarke): I beg to move, That this House doth agree with the Lords in the said amendment.

Madam Deputy Speaker (Miss Betty Boothroyd): With this it will be convenient to discuss the following: Lords amendment No. 2 in page 6, line 14, at end insert—

(1 A) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in England, he shall direct the relevant Regional Health Authority to consult, with respect to the proposal to establish the trust,—

(a) the relevant Community Health Council and such other persons or bodies as may be specified in the direction; and
(b) such other persons or bodies as the Authority considers appropriate;
and, within such period (if any) as the Secretary of State may determine, the relevant Regional Health Authority shall report the results of those consultations to the Secretary of State.
(1B) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in Wales, he shall consult the relevant Community Health Council and such other persons and bodies as he considers appropriate.
(1C) In subsections (1A) and (1B) above—

(a) any reference to the relevant Regional Health Authority is a reference to that Authority in whose region the hospital, establishment or other facility concerned is, or is to be, situated; and
(b) any reference to the relevant Community Health Council is a reference to the Council for the district, or part of the district, in which that hospital, establishment or other facility is, or is to be, situated."

Amendment (a) to the proposed Lords amendment in line 6, leave out `consult' and insert ballot'.

Amendment (b) to the proposed Lords amendment in line 13, leave out `consultations' and insert 'ballots'.

Amendment (c) to the proposed Lords amendment in line 13, at end add
'who shall not make an order under subsection (1) above, unless those consultations establish substantial support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.

Amendment (d) to the proposed Lords amendment line 17, leave out `consult' and insert `ballot'.

Amendment (e) to the proposed Lords amendment in line 18, at end add
'and shall not make an Order unless those consultations establish substantial support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.

Lords amendments Nos. 3 to 5 and 40.

Lords amendment No. 41, in clause 30, page 31, line 26, at end insert—
(1A) The Secretary of State shall by regulations provide for such consultation as may be so prescribed to be carried out by a Health Board or the Agency, before he makes an order under subsection (1).

Amendment (a) to the proposed Lords amendment in line 2, leave out from 'regulations' to end of line 5 and insert
direct the relevant Health Board or the Agency to consult, with respect to a proposal to establish a trust:

(a) the relevant Community Health Council and such other persons or bodies as may be specified in the direction; and
(b) such other persons or bodies as the Board or the Agency considers appropriate;

and the relevant Board or the Agency shall report the results of those consultations to the Secretary of State, who shall not make an order under subsection (1) above, unless those consultations establish a substantial body of support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.

Amendment (b) to the proposed Lords amendment in line 3, leave out 'consultation' and insert 'ballot'.

Lords amendments Nos. 42 to 44, 118 to 122, 141 to 145 and 171.

Mr. Clarke: The amendments are concerned with the consultation process on the establishment of national health service trusts when our reforms are implemented, beginning in April of next year. In our discussions of the proposed reforms NHS trusts are often referred to as self-governing hospitals. That is a rather simplified description because the NHS units interested in self-governing status as NHS trusts extend beyond hospitals. As far as I am aware, the hospitals interested range from some of the biggest to the smallest. There is also a great deal of interest in NHS units delivering services to mentally ill people and community-based services of one kind or another. There are even two or three ambulance services that are interested in the prospect of having much more control over the way in which their part of the service is run inside the NHS.
This is not the occasion for me to set out again at great length the virtues we see in returning to the NHS much more devolution of responsibility and accountability. That should be given back to those at the sharp end of the service—those people delivering care on the ground—where they have the necessary competence, enthusiasm and ability to discharge those responsibilities properly.
The first NHS trusts will be established in the spring of next year, when leadership will be provided by local people sitting on a board chaired by a leading figure of the locality. That board will comprise executive and


non-executive bodies on the smaller corporate-type model that we are advocating for health authorities and trusts under the regime. Those boards will put forward their particular plans for the development of their part of the NHS. Shortly after the Bill receives Royal Assent—I should imagine by the middle of next month—applications to establish NHS trusts will come to me and the regional health authorities from local enthusiasts. They will set out what they think they could do to raise the quality of care to their patients in their part of the NHS if given the necessary autonomy to do so.
There are many people in the NHS who will welcome the fact that NHS trust status will give them a much greater control over the day-to-day affairs in their hospitals. There are many who are anxious to get away from the detailed supervision of their affairs undertaken by district health authorities, regional health authorities, my officials and Ministers of whatever party is in power. I believe that a further injection of pride will be given to those local units that take advantage of the opportunity to establish an NHS trust. The staff of those units and all those served by them will have an increased sense of identity with the local hospital—their local part of the NHS—that is such a great feature of the service we are discussing.
5.15 pm
The Labour party has throughout bitterly opposed NHS trusts for reasons that have, at times, totally mystified me. Once or twice during our proceedings on the Bill I was struck by the irony of the fact that this particular part of the Bill reverses the policy of the National Health Service Reorganisation Act 1973, introduced by the then Conservative Government. By a further irony I was the Government Whip who ensured that we had a majority when we implemented the 1973 Act which introduced the system of area and regional health authorities. That was done in the teeth of the bitter opposition of the Labour party.
That Act brought to an end the long-standing system of local management of the NHS based on the old hospital management boards and similar arrangements throughout the service. Obviously we are not going back to precisely the way in which the health service was run in its first 25 years. We are introducing much more up-to-date and sensible arrangements that are capable of allowing local decisions. Nevertheless, it is right to go back to a system whereby the NHS, as in its first quarter of a century, brings out the best in local management, enterprise and ideas about how best to deliver care to local patients.
In 1972 the Labour party did not have a clue about why it was opposed to the creation of the health authorities. It firmly committed itself to hand the entire service to local government once it came to power. I remember that the then Opposition spokesman was emphatic about that. The Labour party did not reverse Keith Joseph's reforms, but kept them untouched and untroubled by new ideas from 1974 to 1980. Now the Labour party is dying in the last ditch to defend the rights of the health authorities we created, which were introduced to provide detailed supervision of the day-to-day management of every part of the NHS. The Labour party is defending the right of the district and regional health authorities to second-guess day-to-day management even when we identify local

people who want to take responsibility in their hands through an NHS trust. That is what the debate has been about.
The amendments concern the necessary consultation on the establishment of NHS trusts when I receive applications from those promoters who wish to establish such a trust in their area. There is no change of policy behind the amendments and that is why I made a short plea earlier for us not to spend another five and a half hours talking about this, as we did on Report for reasons best known to those who face me in the Chamber.
I have looked up the Second Reading debate when we first presented the Bill to the House. On 7 December 1989 in column 502 of the Official Report I first made it clear that there would be public consultation whenever an application for an NHS trust was made. On 7 December we had the first debate on consultation, ballots, and so on. No doubt the Opposition will rehearse those arguments as we proceed tonight.
In the past few weeks the hon. Member for Livingston (Mr. Cook) has claimed that things have changed since December and that my timetable has slipped. The hon. Gentleman has been whistling in the dark with some enthusiasm in the hope that the introduction of the reforms will be put back. I recommend the hon. Gentleman to read column 505 of the Official Report of 7 December where I first made it clear that the pattern of service in the first year of our reforms would generally reflect the existing pattern of service, because most people wanted to persist with that existing pattern. The opportunities for change will begin in April of next year. Ever since I produced the White Paper and advocated the reforms, I have made it clear that, thereafter, the changes will evolve steadily with everyone learning from experience. They will take advantage of the greater opportunities that the reforms offer to change the service, raise the quality of care and improve the value for money for the taxpayer from the huge sums of money that the Government are not committing to the NHS.
Our response to the repeated concerns that have been expressed in the House and in another place about how the consultation should be run and whether we really meant what we had repeated time and again—that there would be public consultation—was put into the Bill in another place. The amendments collectively ensure that a full process of public consultation will be undertaken.
Returning to what I said a few moments ago about the likely state of progress, if we obtain Royal Assent in the next few days, I shall formally invite applications for NHS trust status. My current expectation is that in the next month the people who believe that they will be ready to form the first NHS trusts in April 1991 will put in their applications. I do not have an exact figure, because it is essentially a matter for local initiatives, but I should expect more than 70 applications from the part of the health service for which I am responsible in England. Thereafter, in accordance with the amendments, the regional health authorities will carry out a process of public consultation with every relevant interest, including the community health councils, that appears on the face of the Bill.

Mr. George Foulkes: Will the Secretary of State give way?

Mr. Clarke: I shall give way to the hon. Gentleman, but I stress that the numbers to which I referred relate to England and not to Scotland.

Mr. Foulkes: I appreciate that the Secretary of State was talking about the figures for England. However, he will agree that the principles remain the same north and south of the border. The new Ayr hospital is being set up in my constituency and the local health board informs me that there has been an expression of interest in self-governing status. From where does the Secretary of State expect that expression of interest? About whom is he talking and what groups does he expect to come forward with such proposals? If the vast majority of senior doctors and consultants in an area are against NHS trust hospitals, would he consider it viable to go ahead? I am asking not whether it would be acceptable or possible but whether it would be viable.

Mr. Clarke: The applications that I am expecting will come from groups of people comprising local clinicians, local nurses, local managers and perhaps local figures such as business people who may have had previous experience of the health service who, as a group, will put forward a proposition for the local NHS trust management of a particular unit. The formal applications will identify who is putting forward the proposals. I expect that most of them will identify the prospective chairmen and the people who would like to be members of the board. Most importantly, the applications will be the documents on which the consultation will be based and will set out proposals of that group for the management of the unit and the development of its services. It will set out the case for saying that that group should manage the unit with NHS trust status rather than continuing with the present direct management by the district health authority in England or the health board in Scotland.

Mr. Foulkes: Is the Secretary of State aware that in Ayrshire, and I am sure elsewhere, there was no local spontaneous request for NHS trust status? The only reason anything is happening is that Don Cruikshank, on behalf of the Under-Secretary of State for Scotland, came and stirred things up. The managers of the hospital were promised that they would get phase 2 only if they were to consider trust status. They were then offered free the services of a consultant firm who will put up a package and stimulate interest in it. Interest is being stimulated centrally by the Minister and not locally. The proposal is being strongly opposed locally. It is being imposed from the centre by the Government without any local interest or support whatsoever.

Mr. Clarke: I do not know this Don Cruikshank, but he sounds a very enterprising fellow.

Mr. Foulkes: He runs the health service in Scotland.

Mr. Clarke: I am not responsible for the Ayrshire hospital. I would advise the inhabitants of Ayr to wait and see who is really promoting the reforms and what they say. I cannot gainsay what the hon. Gentleman says, because, as he knows, I do not have direct contact with the health board in Ayr—that is the responsibility of my hon. Friend the Under-Secretary of State for Scotland—but I know from my experience in England that opponents of NHS trusts have been given the most extraordinary descriptions of what is happening. The debate in the country has often

been based on wild claims by the Labour party and local trade unions which will be gainsaid in July when real applications and promoters set out their plans. We are putting on the face of the Bill our commitment to consultation on our reforms and the nature of that consultation when we move on to much more sensible discussion.
So far, people keep carrying out ballots among consultants and staff and local authorities organise ballots among members of the public based on daft literature giving daft descriptions of what they say is going on in the hospitals. I shall come on to some of the daft literature in a moment, as most of it is being put out by the hon. Member for Livingston. In July, for the first time people will be putting forward proposals for improving their local hospitals and, as I said on Second Reading, wanting serious local discussion on the issues involved and the future quality of care and access to services for the local residents if NHS trust status was approved and went ahead with a particular collection of promoters.

Mr. Thomas Graham: Does the Minister realise that it has been proposed that the local hospital in Inverclyde should opt out? Why is he frightened of democracy and the right of local people such as the people of Inverclyde to conduct a ballot? There is a demand for a ballot. I thought that a ballot represented the process of democracy. The Conservative party is in government as a result of that process, so it should not be frightened of giving the local people of Inverclyde the right to a ballot to decide whether they want anyone other than the health board to run their hospital.

Mr. Clarke: I am grateful to the hon. Members for Renfres, West and Inverclyde (Mr. Graham) and for Carrick, Cumnock and Doon Valley (Mr. Foulkes) for bringing me up to date on the process in Scotland. I am delighted to hear that applications for self-governing status are likely to flood in north of the border and that there is interest in Ayr and Inverclyde. We have no lack of confidence in ballots. I propose to argue yet again the case against reducing serious plans for local health care to semi-political yes/no ballots among selected groups organised by the local Labour party.

Mr. Graham: That is insulting.

Mr. Clarke: It is not insulting. The hon. Gentleman was not here for the speech of the hon. Member for Livingston, who made it quite clear what his approaches will be when local enthusiasts put forward proposals next month for self-governing status. Was he interested in the quality of care? Was he interested in the health service? Did he want to have discussions about the details of its management? He said:
We shall treat every consultation on opt out as though it were a by-election.
The Labour party has taken that approach to health reforms for the past 12 months. So far it has not produced one serious proposition to reform or improve the national health service. The Labour party's policy could be written on the back of a postage stamp. I regret that, since we first brought forward our proposals, the Labour party has joined some of the professional trade unions, as well as the TUC affiliates, in inventing ridiculous scare stories which they can exploit locally to win votes for the Labour party. I warn the Opposition that, if their reaction to local doctors, nurses, managers and people committed to the


health service putting forward proposals is to run around behind front organisations such as Save our Hospitals, Health Emergency and other groups, trying to terrify patients into voting for the Labour party against illusory fears, it will rebound on them very badly.

Several Hon. Members: rose—

Mr. Clarke: I shall give way in a second.
The National Association of Health Authorities—an association of health authorities in England and Wales—is in favour of our reforms.
Opposition Members will recall the Vale of Glamorgan by-election which they won by making a great deal of health service reforms. It was quite clear in Glamorgan that at that early stage, the Labour candidate and those helping him had persuaded the public in Glamorgan that our health reforms meant that they would have to pay for their treatment. That sort of by-election campaign is distasteful and discredits the Labour party. It should not repeat it on the consultation process on the NHS trust. I have my hands on a document that makes it quite clear that it intends to repeat that scurrilous behaviour.

Mr. David Winnick: Is the Secretary of State aware that, given his position, he is quite right to be cautious and wary of balloting or any form of democracy, rather like the leaders of the old eastern Europe countries? Is he aware that in my borough, where the Manor hospital is on the list, there was a household referendum organised by the council with questions approved by the health authority that is keen—at least the full-time administrator and Tory chairman are keen—on opting out? That authority agreed that the questions were fair. In the referendum, 78 per cent. said that they were opposed and 17 per cent. were in favour. Given those figures, is it not clear that the reason the Secretary of State does not want balloting is because he knows very well that he would lose by a landslide majority?

Mr. Clarke: As I said on 7 December, we shall have public consultation when we have the local plans and sensible local discussion. The eventual decision must wait for production of those plans so that their quality can be evaluated. In Walsall and elsewhere, the Labour party has jumped the gun before the proposals have been made so that it can describe them as it likes. Some Labour local councils have money coming out of their ears because of the community charge that they have levied. They have spent much of their charge money on political propaganda and telling the local population that their hospitals are under great threat. They then carry out ballots on the issue. Money has been wasted on political propaganda by elected councillors in places such as Redditch and Walsall.
The National and Local Government Officers Association is pouring money into groups such as Health Emergency and Save Our Hospitals a long time before anybody knows what is proposed for local hospitals. That is what lies behind those ridiculous ballots. That may be repeated—we have been promised that it will in the summer. I think that there will be a proper process of public consulation. The public are concerned about their health service. Sensible people will read the documents and discover what is proposed. I hope that they will make

proposals about what they would like to see in the service. The Labour party's campaigning will be seen as irrelevant and something that tries to exploit fear.
The Labour party thinks that this is all about a by-election and wants to reduce the issue to the organisation of local ballots. When the health service was first set up by my great predecessor, Nye Bevan, it was a controversial change. No ballot of any kind was organised in 1948. In the 1945 general election both parties were committed to the national health service, but setting it up was controversial—doctors voted 9:1 against Nye Bevan and his suggested contract. Quite rightly, he took no notice of the 9:1 ballot because he discussed the matter seriously in the House and got his majority. In the intervening 40 years, no Government have ever thought it sensible to organise a ballot, among whatever electorate, on the details of the management and financing of local hospitals.
Let us take the example of a medium-sized firm in the constituency of the hon. Member for Walsall, North (Mr. Winnick). Locks and chains are no longer made in Walsall, but let us imagine any modern and thriving town. No one would believe that changes in the management of a local firm should be the subject of a ballot organised by Walsall council, subject to leafleting by local trade unions. Whatever products are made in Walsall, I dare say that they are less important than the services given by the national health service. There are few things more important than the health care given to our population by the national health service. Therefore, we should have the highest standards of management, efficiency and value for money in the NHS. We should not reduce its management to a political circus for the benefit of Opposition Members who want to fight by-elections on the back of it.

Mr. Derek Fatchett: I have heard the Secretary of State make that argument before, and I have never found him convincing. I remember the Secretary of State in one of his previous roles in the Government—as Secretary of State for Employment—advocating the extension of ballots in connection with trade unions and industrial relations. He seems to cut his cloth conveniently according to which job he holds. The Secretary of State says that management issues should not be subject to ballots. He also says that key social and political issues should not be subject to ballots when they affect important services such as the national health service. How does he square that with the way he voted on opt-out schools, where a ballot must take place on the management of the school and a resource that is of great importance socially —of equal importance to the national health service? Is it just that the Secretary of State finds it convenient to cut his cloth in one direction for the health service, because he knows that he will lose the ballot, and in another direction on opt-out schools?

Mr. Clarke: I am glad that I eventually persuaded Opposition Members with my arguments on trade union ballots. I remember that they were against them, said that scabs would interfere with the proper running of trade unions, and restrict their right to take industrial action against whoever they pleased. With teeth clenched and holding back their wilder colleagues, Labour Members now say how much they welcome the introduction of ballots for trade unions, so that strikes can be organised only with the consent of union members. I hope to


persuade the hon. Gentleman with my arguments today. We have just agreed to debate these amendments for eight hours—I know that we are covering some familiar ground.
Education involves a tightly knit group of users. We are not talking about ballots of staff alone. It is not just the teachers who make the decisions, because they do not own the school. We do not run workers' co-operatives in education or health. But there is a defined group of people at any one time—a set number of pupils—who receive the service. They are the only ones directly receiving the service and their parents are the ones who are offered a vote on education.
In the health service there is hardly any unit or hospital where the catchment area is so predictable. We do not have hospitals that serve only the people who live in the same borough and do not take people fom outside. Plainly, the staff are not a group of people who can decide about management because the hospital does not belong to them. With the greatest respect to consultants—who are probably the key staff and deliver the service—the hospital does not belong to them. Consultants are always described as though they are some sort of amorphous, block body. There is a huge difference between consultant orthopaedic surgeons who have beds and admit patients, consultants who may be academics with contracts, anaesthetists and radiographers. Consultants are not a set body of people with one collective set of interests and views.
The public served by a hospital come from anywhere. If any of us were to be ill tomorrow in this Chamber we probably would not have the first idea to which hospital we would be admitted. Therefore, there is no electorate among whom we could organise the ballot. The health service is such a giant organisation and so complex that it is not patronising to say that scarcely any member of the public understands how it is managed and financed. One problem is that it is such a chaotic system that not everyone inside it knows how it is managed and financed.
The idea that the document proposing how it should be run in future should be based on some electors who answer a simple yes/no question about the development of services in their district, guided as they will be by the sort of rubbish put out by the Labour party in leaflets while consultation is being carried out, is bad. It would be irresponsible to run a great national service such as the NHS in that way. The Labour party is irresponsible and has no ideas for the service. Its members see this as an opportunity to make mischief and win votes by terrifying old people about the service that they are likely to get.

Mr. Alun Michael: The Secretary of State appears not to have learnt the lesson of the Vale of Glamorgan by-election when there was a thorough discussion about the health service and the nature of the health service that people want. Our excellent candidate, and people such as my hon. Friend the Member for Livingston (Mr. Cook) and others who thoroughly debated the health service, received a positive response and people responded positively to our proposals for the health service. As we seem to be educating the Secretary of State about what is happening outside England, let me bring him up to date on the position in South Glamorgan. At present, the South Glamorgan health authority is scrabbling for cuts worth £7.2 million—

Madam Deputy Speaker: Order. The hon. Gentleman is intervening. Whatever else we do in this Chamber, we do not fight by-elections all over again.

Mr. Clarke: As the hon. Gentleman knows, I am not responsible for the South Glamorgan health authority. Welsh Question Time would be a better place to raise such matters.
Let me move on to the kind of consultation that we envisage. I have described what I want.

Mr. Tony Favell: I have not had the advantage of listening to the Committee's deliberations. As my right hon. and learned Friend knows, I am a simple fellow and I should like a simple answer to a simple question. Will the patient be better off with a self-governing hospital or with the great bureaucratic trail which, in Stockport, for example, goes from the hospital to the Stockport district health authority to the North West regional health authority to the Elephant and Castle to the Treasury and then all the way back down the trail?

Mr. Clarke: My hon. Friend's question makes it clear potentially where the answer lies if the NHS trust is well judged and the right local people have the right local plans. The first part of his beguilingly simple question is the key for all members of the public. When I, as Secretary of State, look at applications for NHS trusts, I shall make the final decision on the basis that he suggests in the first part of his intervention: is a self-governing trust likely to improve the service to the public and will it be in the interests of the NHS to have that degree of local freedom? I hope that we shall then have non-political, serious, local discussion involving those who work in the service, those who are served by it and anyone who has a sensible proposition to put forward.
The Labour party will apparently join in that three-month public consultation. It does not always join in. Often it joins in behind the shield of organisations with names such as Hospital Alert, Health Emergency and Save Our Hospitals, into which the public's community charge has been tipped. The BMA is also promising a great campaign. The BMA and the Labour party ran a pretty silly campaign last summer and they appear to be saying that they will run the same one this year.
The Labour party's document "A question of trust" contains its manifesto for opt-out ballots. Yet again, it shows that all these months in it is still proposing to go round this summer putting out exactly the same myths. I have never used the phrase "opting out" to describe the proposals, because it does not describe them. The hon. Member for Livingston and his hon. Friends continually talk about hospitals opting out of the NHS. The hon. Gentleman has the courtesy to agree that that is his case. He is not on the stumps now; he is in the House of Commons. He knows that nothing will leave the NHS. NHS trust status has nothing to do with a hospital leaving the NHS. It is local management within the NHS and it is utterly untrue for him to sit there rah-rahing in words that he uses on the platform, saying that such hospitals will be leaving the NHS.
5.45 pm
The treatement will be free. I have already mentioned the Vale of Glamorgan by-election where electors were clearly told that they would have to pay for treatment.


That has all been repeated in the document. It uses weasel words. Anyone reading about the opt-out ballots that the Labour party is running will see the heading
Treatment will not be accessible".
I will not read what follows, but there is nothing that describes the reforms which remotely justifies that statement. Then it says of treatment,
It will not be free.
That is an utterly disgraceful assertion.
The Labour party has pressed for public consultation and the amendments, which it will not vote against, give the public the consultation that it has demanded, but its response is to issue guidance which will result in anyone following it not telling the truth when he tries to get Walsall council or some other band of idiots to hold a local ballot and get a negative answer.

Mr. Robin Cook: The Secretary of State takes exception to the term "opt out", but he will confirm that, after he has made an order, such hospitals will be run by a board of directors which will own the property and have full legal title to it with the freedom to sell such part of the property as it chooses. That board of directors will hire and fire everybody employed in the hospital and be responsible for balancing the hospital's books by trading in services and being responsible for raising every penny by selling the services. That board of directors has the freedom to go to the City of London and borrow on the private market. Under the Bill, the board of directors has the freedom to make profits and retain profits year to year. There is no material particular in the ownership and structure of such hospitals which differs from any Nuffield or BUPA hospital.
If the Secretary of State is so confident that the statements in that document are weasel words which cannot convince anybody, why is he so afraid to let the local people decide? Does he not understand that the arguments that he has been advancing for the past half an hour are precisely the same arguments that Wellington used against the Reform Act 1832—that elections were too complex, that they could not be reduced to simple decisions and that people were not sophisticated enough to understand the issues? Why does he not have the courage to put his policies to the decision of the electorate?

Mr. Clarke: The hon. Gentleman repeats on the Floor of the House the kind of nonsense that he puts about outside and—here I congratulate him—without the trace of a smile or a flicker of his beard, although he must know that the NHS trusts that we are talking about bear not the slightest resemblance in any serious particular to a BUPA, Nuffield or any other private hospital. The land for which they are responsible will remain NHS land. Local NHS managers will be empowered, as local managers are now, to sell up to certain limits, but above a low limit they will require the consent of the Secretary of State before they dispose of land. The patients will be NHS patients, not paying a bean for the service, receiving it free.
Contrary to another untruthful statement in the document, the staff will all be NHS employees. They will be public servants receiving public service pensions. They may agree with their local management to vary from the national pay rates in the NHS, but they will be NHS staff. The board will not have any shares in anything, because there will not be any private capital. No profit will be made. Nothing will be distributed to anybody. It will not be a commercial undertaking.
The hon. Gentleman makes my case by getting up and giving us a fantasy vision of an NHS trust as some kind of private hospital when he knows, or should know after hundreds of hours of debate, that what he has just described is nonsense and a travesty of our descriptions of how to run the NHS better with the right local promoters.

Mr. Andrew Rowe: Will my right hon and learned Friend confirm that there have been informal discussions with one of my local district health authorities about the real possibility that the whole district might become self-governing, which clearly demonstrates the rubbish being talked by Opposition Members?

Mr. Clarke: I am grateful to my hon. Friend. Many people in the service are enthusiastic. We have always promised full public consultation on proposals. The amendments put in statutory form the public consultation that we promised, and they should have allayed all the serious fears. There are no serious fears on the Opposition Benches; there is mere political opportunism that if Labour Members misdescribe the proposals enough they might win a few votes for the Labour party in the course of the public consultation process. That will be irrelevant to the public consultation process. There will be a serious discussion about how best to improve the local health service.
I invite the House to agree with the Lords in the relevant amendments to ensure that public consultation has a statutory foundation and that we can put our repeated promises into effect.

Ms. Harriet Harman: If the Secretary of State is as confident as he seems to be that these proposals are minor, technical, managerial matters which seem to be engendering a new breed of people whom he describes as local enthusiasts, why does he not agree with our amendments? Why does he not agree that there should be a ballot, or that after consultations have been held a hospital should opt out only if there is support for it to do so?
When the right hon. and learned Gentleman talks about not taking seriously local people's views about whether their hospital should opt out, he underplays the importance of opting out, implying that it is a minor, technical change. Yet elsewhere he stresses that the creation of opted-out hospitals is one of the key proposals, and so it is. That is why people want, and are entitled to, a say in whether their local hospitals opt out of the local national health service. Our amendments, which the Secretary of State will oppose—

Mr. Keith Mans: rose—

Ms. Harman: I shall give way later; I want to develop my argument.
Our amendments would give people at local level the right to stop their local hospital opting out of the local NHS by a decision of the Secretary of State. Under the Bill, all hospitals will be forced to compete for patients in the internal market—[HON. MEMBERS: "And why not?"] Patients will lose choice because the quality of care will suffer as hospitals cut corners, competing to win contracts by reducing their costs. The internal market will affect all hospitals—

Mr. Mans: rose—

Ms. Harman: Not now.
Opted-out hospitals are to be the leading edge of the internal market. They are to be the market leaders, as the Secretary of State would describe them in his salesman's jargon.
To play this role, opted-out hospitals are to be cut loose from their local communities. No longer will they be directly managed by the local district health authority; no longer will they be an integrated part of local hospital and community services. There has been much talk of the freedom that will be bestowed on opted-out hospitals—the freedom to drop uncompetitive services if they are expensive and do not bring in enough revenue, for instance. These will be services such as those provided for the long-term chronically ill, geriatric patients and the mentally ill.
Opted-out hospitals will have the freedom to divert services to private patients—[HON. MEMBERS: "Not true.] I suggest that hon. Members read the Bill, because I am basing my comments on it.
Opted-out hospitals will have the freedom to divert services to private patients to stoke up their income. They will have the freedom to bid for contracts and perhaps draw in patients from other district health authorities by offering waiting times so as as to get bigger contracts from neighbouring health authorities.

Mr. Jerry Hayes: Would the hon. Lady be kind enough to be straightforward and tell us precisely where in the Bill all her allegations or even the suggestion of those allegations come from? She knows very well that what she has just said is wholly inaccurate, because district health authorities—and, if need be, the Secretary of State—will be able to intervene if there are local eccentricities of the kind that she suggests.

Ms. Harman: In Committee we proposed amendments on all these points which would have prevented opted-out hospitals being cut loose from their local communities, and the hon. Member for Harlow (Mr. Hayes) among others, voted against them. We proposed amendments that would guarantee local access to core services for the elderly, for children and for psychiatric patients, but they were voted down. We tried to put safeguards in the Bill, but the Conservatives voted them down—

Mr. Mans: rose—

Ms. Harman: I shall carry on for a bit.
It has been suggested that opted-out hospitals will have the freedom to bring in patients from Europe. The location of St. Thomas's hospital at the channel tunnel terminal is seen as a wonderful opportunity to provide services to patients from Europe. But that is not how people living near St. Thomas's, who want to use the hospital see it. They know that they will lose. When opted-out hospitals exercise their muscle in the market place, local people will be the losers. If they are unfortunate enough to need one of the services that have been dropped as uncompetitive, they will no longer be able to turn to their local hospital —they will have to go elsewhere. The so-called guarantee of local access to certain key services described as core services, which had pride of place in the White Paper, has no place in the Bill.

Mr. Hayes: rose—

Ms. Harman: Local people have no guaranteed right to those core services in an opted-out hospital. In Committee, the Government voted down our attempts to guarantee local access.

Mr. Hayes: rose—

Ms. Harman: The hon. Gentleman was there; he knows that they voted down our guarantees of local access to services for children, the elderly and the mentally ill—

Mr. Hayes: rose—

Ms. Harman: I have already given way once to the hon. Gentleman, and I know that he will seek to catch the Chair's eye later.
If private patients prove more lucrative than local NHS contracts—[Interruption.] I hope that the hon. Member for Harlow will listen to what I am saying. He seems to be getting agitated.
If private patients prove more lucrative than local NHS contract patients, local people will lose out to patients under contract from BUPA, to which the opted-out hospital could be selling its services—or the French equivalent might even come first. If a neighbouring consortium of district health authorities which had formed themselves into a purchasing consortium wanted to place a large contract for a large throughput of patients, to win that contract an opted-out hospital could agree terms which gave patients under that contract preference over patients from the local district health authority. There is nothing in the Bill to stop that. There is no reason why opted-out hospitals should not act in that way as they will no longer be part of the local health authority. That is the whole point of opting out.

Mr. Kenneth Clarke: Perhaps I may reassure the hon. Lady. The only proposals in the service for consortia of district health authorities for purchasing purposes are coming from district health authorities which contain self-governing units. Local district health authorities would put together what is usually called their purchasing roles—I prefer "planning roles"—to put themselves in a stronger position to stipulate the quality and sort of care that they want from the self-governing hospital in their territory.

Ms. Harman: The Secretary of State does not understand how his internal market will work. Consortia of local district health authorities coming together to increase their purchasing power need not buy contracts only from their locally managed hospitals or even from their local opted-out hospitals. They could buy contracts with other local opted-out hospitals. The right hon. and learned Gentleman's argument does not, therefore, negate what I have said. The situation is exactly as I have described it: large purchasers can arrange contracts with opted-out hospitals in such a way that people coming under the contract offered by the consortium of district health authorities would receive care in preference to local people.
Opted-out hospitals will not look to their local communities because the chairman will be appointed by the Secretary of State. The Secretary of State's appointees in the regional health authority will appoint the non-executive directors. The chairman and non-executive directors—direct or indirect appointees of the Secretary of State—will appoint the non-executive directors, so the


focus will be on the Secretary of State, not on the local community. That is why local people whose hospitals are targeted for opting out see it as a threat and want to have a say.
All the talk about local enthusiasts springing up all over the place is nonsense. People who work in hospitals want to have a say because they care about the services that they help to provide and because they feel that they know about patient care. They also want a say because they would no longer be employed by the district health authority under Whitley terms and conditions. The Secretary of State said that those people would still be national health employees and that hardly anything would change. We spent many hours in Committee discussing clause 6. I remind the Secretary of State that that clause provides for the transfer of staff from health authority to national health service trust employment. Without their approval, they would no longer be employed by the district health authority but by the opted-out hospital. Of course they should have a say.

6 pm

Mr. Clarke: At present staff can be transferred from one district health authority to another if a particular part of the service is transferred. People may be transferred from an authority to a trust, but they will still be national health service employees. The Labour party pamphlet on that is plainly wrong when it claims that the staff will not be national health service employees.

Ms. Harman: The Secretary of State seeks to mislead the House. People who transfer from one district health authority to another retain the same Whitley council terms and conditions. Staff who transfer from a district health authority to an NHS trust will take with them their contract of employment, but they will not take with them their right to trade union membership and to have their trade union recognised to negotiate on their behalf. The contract of employment, which is backed by a national structure of union recognition, would therefore be nothing more than a piece of paper. The Secretary of State knows the difference between a contract of employment backed by nationally recognised negotiating procedures, and a piece of paper, the contents of which are unenforceable.

Mr. Clarke: I think that the hon. Lady has conceded that such people will remain national health service employees. She has moved on to what she is really worried about—that local management might choose not to be governed by Whitley council national rates. That is what the Labour party wants to defend. People might choose to recognise their own local trade unions. As the hon. Lady knows, the Whitley council arrangements cover trade union representatives such as those from the General, Municipal, Boilermakers and Allied Trades Union on the ambulance men's Whitley council who do not have any members working for the national health service in that grade. The recognised trade unions at Whitley council level include trade union representatives who may have no relationship whatever with the trade union membership of that grade of staff in a local hospital or unit. People will remain NHS employees, but they can be represented by local unions of their choice.

Mr. Martin Redmond: On a point of order, Madam Deputy Speaker. The Secretary of State has moved a guillotine motion to restrict debate on this

important Bill. He is now seeking to utilise the little time that we have with a series of interventions. If he wants time to discuss the matter further, he should lift the guillotine.

Madam Deputy Speaker: That is not a matter for the Chair. The hon. Member for Peckham (Ms. Harman) had given way. I think that the Secretary of State has finished his intervention.

Ms. Harman: One of the advantages canvassed by the Secretary of State in support of opted-out hospitals is that they will have the freedom and opportunity to cut through nationally agreed pay terms and conditions, and he has said that people will not necessarily have their union recognised. People should at least have a say before their terms and conditions of employment are changed so materially.
The Government have made contradictory statements about consultation. They were finally backed into an amendment in another place which would require consultation before opting out. We support that amendment, because the Government should of course consult. If consultation is to have any meaning, the Secretary of State must not just consult but must take that consultation into account. The Government amendment says that there will have to be consultation, but there was fierce opposition to our amendment which said that they should take into account the results of such consultation. Unless they take that course, they will make a mockery of consultation. It would be a sham for the Government to proceed with opting out after they have consulted and found no substantial support for opting out among the local community or the staff.
We know why the Secretary of State opposes ballots. He is redolent of sincerity, so he has clearly undergone some sort of psychological transformation. His arguments about ballots are ludicrous, but he seems to believe them. Anyone not in the same peculiar state as the right hon. and learned Gentleman will realise that he and the Government are against ballots because they know that they will not be able to win them. The Secretary of State said that there was no ballot about the creation of the national health service. But there had been a general election—that was the ballot.
The idea that the subject is too complicated for patients to understand is ludicrous and insulting. I presume that the Secretary of State also thinks it too complicated for consultants to understand and that that is why they should not be entitled to a ballot. He said that a ballot is not held for a Walsall lock and chain factory, so why have a ballot when a hospital wants to opt out. He does not seem to realise that people throughout the country regard the national health service and their local hospital as very different from the local lock and chain factory.
The Secretary of State's opposition to ballots is based purely and simply on the fear that they will show overwhelming opposition to opting out. The ballots already conducted have shown a tide of opposition. No matter where they take place, who conducts them or what the question is, the Secretary of State can find no support for his proposals. He talked about our "misleading leaflets", but he has spent millions of pounds of taxpayers' money on grotesquely misleading leaflets. Yesterday I picked up 12 leaflets produced by Trent health authority involving a scandalous misrepresentation of the effect of the proposals.

Mr. Clarke: What are they?

Ms. Harman: There are 12 of them. I do not want to go through them all, but I will write to the Secretary of State.
Despite spending millions of pounds of taxpayers' money, the Government have failed to win the argument and lull people into a false sense of security. Their propaganda has not worked. That is why they fear ballots. I shall give a few examples. People working for the West Lambeth health authority were balloted and 82 per cent. were against applying for self-governing status and 18 per cent. were in favour. In Doncaster, which I visited yesterday, the borough council commissioned a MORI poll and found that 68 per cent. of people were opposed to the local hospital, Doncaster royal infirmary, opting out.
The Secretary of State says that such ballots are a waste of money, but they would not be a waste of money if he paid some attention to them. It is a waste of money to test public opinion only if there is a determination to ride roughshod over it. General practitioners local to Guy's hospital were balloted and 66 per cent. were against that hospital, to which they refer their patients, opting out. In the 28 hospitals where ballots have been held, even consultants have voted by a ratio of 2:1 against their hospitals becoming self-governing. The Secretary of State says that the local enthusiasts who seem to be covering the country include enthusiastic consultants. Mr. Paddy Ross, chairman of the BMA consultants committee, says in a letter:
I remain very concerned about the fact that in many of the front-runner hospitals, plans for self-government still appear to be progressing despite clear evidence of lack of support from consultant staff. We have identified some twenty eight hospitals on the Department's list of those likely to progress to Trust status in April 1991, where recent ballots of consultant staff have been held on the issue of self-government. As you will see from the results of these ballots, in 2l of the hospitals the consultant staff have overwhelmingly rejected the concept.
Already some expressions of interest have been shaken out of the system because of the overwhelming hostility which the Secretary of State knows exists. In January 1989 the White Paper triumphantly trumpeted that 320 hospitals would be available to opt out. In June 1989 the figure was only 189. In November 1989 it had dropped to 79. In May 1990, although the Secretary of State still holds out that about 70 hospitals are interested in opting out, the chief executive said that 50 hospitals were likely to become self-governing trusts. Already hospitals are being shaken out in recognition of the overwhelming local opposition to opting out.
The Secretary of State says that even consultants' views will be overridden if they dare to oppose opting out. Now only the views of the patients matter, but we are not allowed to ask the views of the patients—the only person who knows the views of the patients is the Secretary of State, so only he can make the decision. His tactics of public misinformation simply have not worked.
Let us consider the tactics used with the consultants. The tactic with the public was misinformation, but with consultants it has been slightly different. First, the tactic was to ask consultants, "Why do you not express an interest? Expressing an interest does not commit you to anything. All it says is that you are interested in finding out more information." Of course, as soon as they were lured into an expression of interest, consultants were immediately written down as fully in support of opting out. The first tactic was to lure consultants into expressing

an interest because it hardly made any difference. But they would be ridiculous if they did not want information about what might affect their local area.
After the "expression of interest" tactic, a combination of blackmail and bribery was used. That was referred to by the hon. Member for Carrick, Cumnock and Doon Valley (Mr. Foulkes). The Government said, "We will see you all right if you opt out. You know that this is a highly political matter for us and we will see you all right if you are one of the first opt-outs. You know—nudge, nudge, wink, wink—that we cannot afford to let you fail. But if you do not opt out you have a large deficit to worry about. It looks like phase 2 is in doubt and you can forget phase 3." That was the message sent round to browbeat consultants who disagree with the internal market and opting out into believing that they should vote to opt out as the only way in which to survive in the jungle. That is disgraceful. Despite that tactic, the Secretary of State has failed to take the consultants with him.
I should like to take this opportunity to make our position clear. One of the Secretary of State's most annoying misrepresentations is his misrepresentation of our position. I will state it in words of one syllable which I hope that he will understand. We do not agree with the internal market. Health care is damaged by the fragmentation of the services into competing units. We do not agree with riding roughshod over public opinion when people do not want local hospitals to opt out. We believe that people should be consulted and that their views should be taken into account. We make this promise to people whose hospitals are threatened with opting out. The Government and the Secretary of State might not be prepared to listen, but we are. That is why we shall press these amendments to a division.
I finish by repeating the words of Ken Gibson, an 80-year-old gentleman whom I had the opportunity to meet when I visited Doncaster royal infirmary last night. He said, "During the war we brought sandbags to the Doncaster royal infirmary to protect our hospital from the enemy. We have been fighting to protect our hospital ever since. It is our hospital. It is not the Secretary of State's to give away." I believe that people such as Ken Gibson should have the right to vote on the future of his hospital and to have his views taken into account.

Sir George Young: I hope that the House will agree with the Lords in the amendments and will reject the amendments tabled by Opposition Members. I simply cannot understand why the Labour party makes such heavy weather of the establishment of self-governing trusts within the national health service. I should like to give three reasons why it is wholly misguided in what it plans to do this afternoon.
First, we already have self-governing trusts within the NHS. General practices and health centres in many constituencies are self-governing trusts within the NHS. They are the most popular and successful model of management within the NHS. The Bill proposes to extend that model of management to other parts of the NHS. The people who work in health centres and general practices decide how the unit should be operated. Any savings are ploughed back. Such centres are responsive to local needs and are not involved in the bureaucracy of the NHS. The Government seek to extend that successful, popular model


of management to other parts of the NHS. The Labour party is making a fool of itself by seeking to prevent the extension of that style of management.
Secondly, we already have self-governing trusts within the public sector. We have established them in education and on roughly the same model in housing, where it is fairly common to devolve the management of estates to local people.

Mr. Keith Bradley: What about ballots?

Sir George Young: I shall come to the issue of ballots in a moment.
We heard all the same propaganda that we heard from the hon. Member for Peckham (Ms. Harman) today when it was proposed to allow schools to become self-governing. None of the fears expressed this afternoon materialised with self-governing or grant-maintained schools. Such schools are popular. Some were given grant-maintained status by the Secretary of State and others were not. 1 should be surprised if any Labour Government said that they planned to nationalise or bring back under local authority control some of the popular grant-maintained schools that have been established.
We have made it possible for local authority tenants on an estate to run the estate themselves. We have devolved the management of such estates. The Government are not afraid of ballots on such issues. We have established arrangements for ballots on grant-maintained status for schools, on the creation of housing action trusts and on the transfer of new town property to local authorities.
The reason why ballots are not practicable for NHS trusts were given by the Secretary of State. The electorate is well defined for a ballot on a housing action trust, on new town property or on a school. The electorate for a hospital or ambulance service is not well defined. We have established that it is simply not practicable to hold a ballot on whether an NHS trust should be created.
I now come to my third reason. I suggest that Opposition Members read an Adjournment debate initiated by the then Bob Mellish, now Lord Mellish of Bermondsey, in 1979 about St. Olave's hospital in Bermondsey. The thrust of his argument was that St. Olave's was run far better when it had a board of governors. He wanted to return to the days when people identified with their local hospital, the hospital was run by local people and it was easier to raise money for it. He deplored the transfer of the management of St. Olave's from the board of governors to a district health authority.
The Bill seeks to give the opportunity to Bob Mellish—were he still here—to support the reversion to local management of St. Olave's and many other hospitals. I suspect that if he were in the House this afternoon he would speak in favour of devolving management—[Interruption.] I see that the hon. Member for Sheffield, Hillsborough (Mr. Flannery) agrees with me. Bob Mellish would be on this side of the argument. He would argue for local control and against the bureaucracy of the NHS.

Mr. Robert N. Wareing: The hon. Gentleman told the House how wonderful it was to have ballots in the schools sector. Is he really saying that it is impossible and inconceivable to hold a ballot of local people who, after all, are the consumers of the national health service? Is it not possible within every community health council to hold a ballot? When were CHCs

consulted? Is the hon. Gentleman saying that democracy is too inconvenient for administrative reasons, or is it really for political reasons, of which the Government are all to well aware?

Sir George Young: I am not sure whether the hon. Gentleman was in his place when the Secretary of State dealt with that point. He made it clear that, if any of us were taken ill, we should not have the slightest idea which hospital we might be referred to. It is impossible to define the catchment area of large hospitals such as Bart's and Guy's. Many cottage hospitals were closed by the Labour Government. There was no ballot then. That was a far more dramatic decision for local people to cope with than the change of management that we are debating.
The hon. Member Livingston (Mr. Cook) said that every proposal for self-government would be treated as a local by-election. There have been four local by-elections in Ealing during the past two years, three in Labour-held wards and one in an Alliance-held ward. The Conservative party won all four by-elections. If the Opposition want to have a fight about this in Ealing, I suspect that they will be on dodgy ground.
If a proposal is put forward that a hospital in my constituency should become self-governing, we shall consider it on its merits. We shall not be influenced by the fact that the Labour party is campaigning against it. We shall consider whether it would be good for local people. If it would be good for them, we should back the proposal. If we decided that it would not be good for them we should not back it. For the Opposition to try to turn this into a popularity contest between the two major parties is wholly counter-productive. I welcome the amendment. I hope that the House will support it.

Mr. Winnick: I apologise, Madam Deputy Speaker, for the fact that after I have finished my speech I shall have to leave the Chamber to see whether the Select Committee on Procedure is still sitting.
The Secretary of State for Health and the hon. Member for Ealing, Acton (Sir G. Young) have put forward all sorts of reasons why balloting is unnecessary and irrelevant. The Opposition know why the Government oppose ballots. If ballots were held they would lose by a landslide. If the Secretary of State believed that local communities would accept his proposals, would he say that balloting was wrong and irrelevant? Of course not. He would say the very opposite. He would argue that the Conservative party believed in democracy and balloting. He knows, however, as we do, that local communities are not in favour of his proposals.
The Secretary of State jeered at what my local council, Walsall, has done. I congratulate it. The local health authority decided not to hold a ballot on the future of the district general hospital—the Manor, as it is generally known. The local authority therefore decided to hold a household referendum. I congratulate it on its initiative. If the Secretary of State suggests that warped and twisted questions were asked in order to get the kind of responses the local authority wanted, I must point out to him that those questions had already been put to the health authority. It was asked whether it approved the questions; it was not asked whether it approved of balloting, because it did not. For the Secretary of State to sneer shows his contempt for the views of the local community.
The result was that 6,004 were in favour and 27,639 against; 78.5 per cent. were not in favour, while 17 per cent. were. The local authority asked people whether they believed that they should be consulted, and 94.7 per cent. were in favour and 3.3 per cent. were against. It also asked people whether they thought that opting out would affect the service that the Manor provides. Fifteen per cent. said that a better service would be provided and 8.5 per cent. said that it would make no difference, but 68 per cent. said that it would result in a poorer service.
The Secretary of State says that those questions do not count. That shows his arrogance. He believes that local people should have no voice and should not be asked for their opinion. To him, democracy is a charade. I do not believe that.

Mr. Kenneth Clarke: rose—

Mr. Winnick: The people in my borough have a deep attachment to their district general hospital. I concede that people do not always know which hospital they will be sent to. People who do not live in the borough are treated—rightly—at the Manor. However, nearly all those in the borough who need hospital treatment are likely to go to the Manor. They have a link with that hospital.

Mr. Clarke: No proposal was put forward by anyone to establish a local national health service trust. The council campaign was all about opting out and threats to local services—hence the Romanian-type election results. Of course we believe that local people should have a say. We have always promised local consultations. The amendments that we are debating are in line with the opinions expressed by 94 per cent. of the respondents, who presumably had been told, quite falsely, by the council that the Government resisted the idea of local consultations.

Mr. Winnick: The best form of local consultation in this matter is democracy. That is the system that has operated in this country since the Reform Act 1834 and the other Acts that allow people to have a voice. We believe that the best way for people to express their point of view is by voting. The Secretary of State refers to Romania. The former Communist leaders in eastern Europe did not want genuine elections to be held. They were, rightly, frightened of democracy. The recent election results in most eastern European countries at least show that they knew that they would be turfed out. That is why the Secretary of State and his Cabinet colleagues are so hesitant about and are opposed to the holding of ballots on controversial proposals.

Mr. Graham: The Secretary of State suggests that those who call for a ballot are influenced by the Labour party. The local Labour party in my area has not called for a ballot; a well-known newspaper, which is not a Labour party paper, called for a ballot.

Mr. Winnick: My hon. Friend illustrates the fact that opposition to the proposal goes far wider than Labour party supporters. The Opposition make no apology for being associated with the campaign. We fought for the creation of the national health service. The Secretary of State quoted Nye Bevan. I imagine that the Tories will soon be claiming him as one of their own. However, we remember the Tory opposition to which he was subjected

in the House of Commons. There was strong opposition from the Conservative party to the creation of the national health service. However, the Labour party has always been associated with the NHS and we are determined to defend it at all costs. Why, therefore, should we apologise about what we consider to be a halfway house towards privatisation?

Mr. David Wilshire: The hon. Gentleman says that he and his colleagues are prepared to defend the NHS at all costs. He has spent the last few minutes, however, saying that fact and truth are important. If I understood him correctly, one of the questions to which he referred—which might have been agreed by the local health authority, though I care not who agreed it—asked whether people were in favour of opting out. If the words "opting out" were used, the truth was not put to the local people when they voted. No such suggestion has been made.

Mr. Winnick: The people in my borough require no lectures from the hon. Gentleman about what they know or do not know. They have followed the debate and they know what the position is. I challenge the hon. Gentleman to allow a ballot to be held on the issue in his constituency and to stand by the result. The result in his borough would almost certainly be the same as that in my borough.
I tabled a written question to the Secretary of State in which I asked him to list the national medical organisation that had made representations to him expressing support for the proposal that national health service hospitals should become self-governing. I received his reply yesterday. Not one national medical organisation seems to be in favour of the proposal. The Secretary of State said in his reply that much of the discussion with the national organisations had been about the detailed implications and practical details of the implementation of the proposals.
The Government cannot name a single medical organisation, and we know why. As my hon. Friend the Member for Livingston (Mr. Cook) pointed out, it is not just the Labour party or the British Medical Association that opposes the proposals—and, incidentally, the BMA is not normally looked upon as a Labour party front organisation. What about the joint consultants committee? I can hardly imagine that that body's representatives are all eager to vote for Labour at election time. The House should listen to what they have to say:
These proposals"—
the opting-out proposals—
inevitably change the prime aim of the management of these hospitals, from the provision of adequate care to the community as a whole to the financial success of the hospitals. The considerable experience of such hospitals in the USA shows clearly that there will be pressure to encourage admission of patients with conditions that can be treated with financial benefit to the hospital rather than to admit those patients—often the chronic sick—whose treatment is likely to lead to little or no such financial benefit.
The joint consultants committee takes the same view as we do; it is highly sceptical and highly suspicious of the Minister's proposals.
6.30 pm
I take the view that, whatever one calls such hospitals —self-governing hospitals, national health service trusts or anything else—they will place a greater emphasis on commercial considerations, on the selling off of land and property. As I said, they will undoubtedly be a halfway


house to privatisation. The Minister argues—as one would expect him to—that they will remain part of the national health service. We know that initially they will, but we also know that the Government are hostile to the national health service and that they seek to destabilise it, even if, understandably, they do not have the political courage to repeal the Act, as many Tories would like them to. After all, the national health service goes against the very foundations of Thatcherite policy and ideology. This proposal is another means of destabilising the national health service.
The hon. Member for Spelthorne (Mr. Wilshire) said that those in my community did not understand the questions in the poll. They understood the questions perfectly well, and they understand what the Tory Government are about. They understand the Government's hostility to the national health service. That is why we are perfectly justified in fighting the proposals all the way.

Dame Jill Knight: The hon. Member for Walsall, North (Mr. Winnick) commonly talks a fair old load of rubbish, but he has excelled himself this evening: I have never heard a greater load of rubbish. His assertion that the Government are hostile to the national health service flies in the face of every single fact —[HON. MEMBERS: "Eye tests?"]—and everything that has been done—[HON. MEMBERS: "Eye tests?"] I am not sure whether we have parrots or Members of Parliament on the Opposition benches. They sound rather like parrots to me.
No Government who have trebled expenditure on the health service can possibly be described as hostile to it. We have far more doctors, nurses and dentists than ever before, and far more in-patients and out-patients are being treated than ever before, and with infinitely more complicated and expensive treatments. The hon. Gentleman's statement flies in the face of the facts.
No Conservative Member has any objection whatever to ballots, but let us ensure that the information given to those taking part is absolutely clear and straightforward. The Labour party has constantly used the words "opting out" to frighten people into voting against hospitals obtaining self-governing status in the straw polls that it has set up. It is a lie that hospitals are to opt out of the health service. No hospital will be opting out of the service. It is quite true that, if people believe the propaganda that the Labour party has been peddling—if they really believe that we intend hospitals to come out of the national health service—they have good reason to vote as Labour Members say they do. But it must be clearly understood, by a far wider public than have so far understood it, that there is not the slightest question of a hospital that opts to become self-governing opting out of the national health service.

Mr. Martin Flannery: Does the hon. Lady know that the Conservative party voted against the health service in the first place? Why does not she admit that the Government are doing all this complex organising and reorganising because, if they dared to tell the truth—that they are against the health service—they would be thrown out? They are doing all kinds of things to pretend that they are not against the service because they do not dare to say that they are.

Dame Jill Knight: That is the last time that I shall give way, as stupid comments take up time and get us no

further. The hon. Member for Peckham (Ms. Harman) said that she objected to Conservative Members saying what the Labour party's views were. I have the same feeling about what the hon. Member for Sheffield, Hillsborough (Mr. Flannery) said. He has not the slightest right to say what the Government intend to do because he does not know. He does not listen and he does not take a blind bit of notice of what the Government have done so far. He made a historical point about the voting on the National Health Service Act. In fact, a Conservative, Sir Henry Willink, was the originator of the terms of what later became the national health service. The Conservative party voted not against the principle of the health service, but against the way in which the legislation was being introduced—[Laughter] This is historical fact. Opposition Members can go to the Library and look it up.
The hon. Member for Walsall, North is fond of quoting the BMA. He may like to remember that, at the beginning, the BMA opposed the national health service root and branch. It has always opposed any changes in the national health service. [HON. MEMBERS: "It was wrong."] The fact is that it was against it. If the hon. Member for Hillsborough wants a history lesson, I shall be happy to give him one. In any case, he can check everything that I have said in the Library. All the facts are there on record.
There is another very important point. Never once have those who have a political motive for trying to hit the Government in any way they can asked the general public, "Are you against bringing back the matron?" In many cases, that is what self-governing hospitals would entail. There is hardly a patient or a patient's relative in the country who would not very much like to have the matron back in place. Hospitals were infinitely better run when we had matrons, and I for one want to see them back. If hospitals are self-governing, they will have their own boards—and they ran very well wen they had them before —and they will have the opportunity, should they wish, to put a matron back in place. Labour Members should try telling their constituents that and see whether they vote against the proposals.

Mr. David Hinchliffe: I make no apology for being somewhat parochial; I suspect the some other hon. Members—certainly Labour Members—will wish to voice their concerns about opting-out proposals in their areas.
In Committee, I expressed my concern that, last December, the district general manager of my health authority in Wakefield proposed that the entire authority should opt out. I was concerned that that had been done without any consultation or discussion with the local bodies that were interested—not even with the local health authority itself.
Since that time I have had vast correspondence from people in my area. Every letter—there are hundreds—has been in opposition to the proposal for opting out, which is the Government's philosophy behind the legislation. I have not received one letter from a constituent who favours what is being put forward by the Government or by the district general manager in Wakefield.
Locally, the whole affair has been a costly shambles. As a direct result of the proposals put forward by the district general manager, the district finance officer was sacked because he had the bottle to say that he objected to the expenditure of scarce national health service resources on proposals for something of which he could not see logic


and which were not supported at local level in any way. In a letter that he wrote to the district general manager before he was sacked, he wrote:
Managers complain of dangerously low levels of nursing staff and in this context they are throwing money away on the issue of the opting out process.
The district health authority in Wakefield has been taken to court by that gentleman for unfair dismissal, being forced to pay £24,000 in lieu of a year's salary—I assume that it was because he was wrongly dismissed—and having to pay out huge amounts on its own legal representation and, I understand, the costs of Mr. Corner, the district finance officer.
I suspect that the whole shambles will cost about £40,000. I shall happily give way if the Secretary of State wants to query that. I am having difficulty obtaining the details, but we know that Mr. Corner received £24,000 compensation. On top of that there was a complicated legal case. In addition, the health authority has had to pay for another officer to replace Mr. Corner since he was suspended and sacked.
The only good thing that has come out of the matter is that the regional health authority has leaned on Wakefield health authority and the district general manager is to take what is termed early retirement. I and everyone in Wakefield hope that he will be joined in early retirement by his proposals for opting out.
Local people should have a say in such matters. People in my constituency have been deeply perplexed and amazed by the events of the opting-out process in Wakefield health authority. They foresee the problems that will arise when opted-out hospitals operate within the context of the national health service. The complete lack of planning of any sort of health care will make it impossible, if we are all competing against each other, to plan a coherent national structure that will respond to known and recognised needs. Hospitals will treat patients who generate the most income. Chronic patients, not the acute sector, will be neglected and forgotten because they do not attract the finances that other sectors can get.
Local people recognise that quality will go by the board, that cheapness will rule and, that the quantity of services will be affected. In future, traditional services—for example, the excellent maternity services in my area—may go by the board and local people will no longer have in their own health authority areas the services that they have had for many generations, certainly since the NHS came into being.
The patient will have absolutely no choice where he or she is treated. My constituents, who, by and large, are utterly opposed to private medicine may end up being treated in a private hospital. It is unacceptable for people who have campaigned and fought for the national health service—a state health care service—to end their days in a private hospital such as Methley Park, which is in my area.
I am aware that many of my hon. Friends wish to contribute to the debate, and I do not want to take up too much time. However, it offends me that the Secretary of State compares the management of a private firm in Walsall to the opting out of the hospital service in any constituency. How on earth can he suggest that there is any common ground between the running of a private company in Walsall and the running of the national health

service? All hon. Members can see the difference. The Secretary of State's remark was stupid, and it illustrates his concept of the national health service.

Mr. Kenneth Clarke: I have never heard a more ridiculous description of what I said. I expressly said that the national health service is much more important, in the service that it delivers, than whatever is manufactured in Walsall. I said that it was irresponsible, therefore, to run the management and financing of a nut and bolt factory in a sensible way but to turn the management of the national health service into a party political football subject to idiotic referenda of the sort that the hon. Gentleman describes.
Wakefield has suffered more than any other part of the health service from the importing into the health authority of party political squabbling for the past five or six years. The difficulty in Wakefield is that different parts of the Labour party argue with each other and bring all their quarrels to the health authority. Every aspect of the health authority's dealings is part of the local industry of propaganda in the newspapers, as the hon. Gentleman has illustrated by even making the hiring and firing of staff and the position of individual officers a matter of party political controversy in which he immerses himself completely. His activities and those of the Labour party have made Wakefield health authority almost impossible to run.

Mr. Hinchliffe: I am grateful to the Secretary of State for that personal tribute.
The right hon. and learned Gentleman needs to read the official record of what he said. I was astounded that anyone could be so naive as to make that remark about the management of a private company. We are talking about a public health service that should be run in the interests of the public. We pay for it. It is beyond me how a comparison can be made between a private company and the national health service.

Mr. Geoffrey Lofthouse: The problem, as my hon. Friend will remember, is not the political aspect of the health authority, it is the health authority's major decision to transfer waiting list money, which would have provided 500 operations at Pontefract general infirmary, to Methley Park private hospital for only 230 operations. Therefore, 270 of my constituents had to continue on the waiting list for operations that could have been done in Pontefract infirmary if the health authority had not decided to transfer that money to the private sector.

Mr. Hinchliffe: My hon. Friend has been active on this issue in the Wakefield area. I am sure that, like me, he resents the suggestion that we have anything other than honourable motives in defending the health authority against some of the Government's attacks and against some of the agents who have been placed in positions of prominence in Wakefield district health authority.
I am aware of the concern of community health councillors throughout Britain about the way in which their role is being eroded. Local authority representatives will be removed from health authorities with effect from next year. We have seen the complete erosion of local


democracy or influence in the health service. It is essential that we support the amendments and give local people a say in their health service.

Mr. Rowe: Not long ago there was a sick joke about a child saying: "Mummy, mummy, mummy, why am I running round in circles?" The answer was, "Shut up or I'll nail your other foot to the floor." When I hear the hon. Member for Peckham (Ms. Harman) I am often reminded of that exchange. In an elegant and vocal way, she runs round and round in circles because her foot is nailed to the floor by her passionate devotion to the over-provision of hospital accommodation in south London. One of the clear abuses of the present administration of the national health service is that there is a dense concentration of very large hospitals in south London which are often so desperate to find patients that they will go trawling round the home counties and beyond looking for people to treat.
That presents a serious difficulty for the Opposition—who are the local people who will decide what should happen to their local hospital? Is it people who have travelled from Hastings, Dover and the south coast of England to be treated at St. Thomas's hospital, or is it the declining population within walking distance of St. Thomas's? It emerged in Committee that the prospect of some of the constituents of the hon. Member for Peckham having to travel four miles to hospital instead of half a mile was a burden too intolerable for her to bear. Patients in my constituency must frequently travel long distances to hospitals like St. Thomas's, because the enormous concentration of resources in south London means that places such as Medway are grossly underprovided with the resources to which they are entitled according to the growing size of the local population. Under the present cumbersome national health service arrangements, they are deprived of services, and I foresee no prospect of the proper quota being reached for a long time.
I am in favour of alternative methods of organising hospitals and other parts of the health service to ensure that local conditions receive rather more consideration than under the present cumbersome arrangements. South East Thames regional health authority and many others delay and increase the cost of decisions that should be taken locally.
The second-guessing that occurs among regional health authorities is probably the quickest way of destroying the morale of good consultants, managers and heads of department in local hospitals. I have said before, but I shall repeat it as Opposition Members' memories are dramatically short, that there is a clear example of that in one of my district health authorities which, having valued its capital stock most scrupulously using the most professional of firms, decided to sell some of its property, to the benefit of its patients. But the regional health authority said, "We are not sure that you have done it right. We shall appoint a similar firm and revalue the entire stock." When it reached almost exactly the result, it discovered to its dismay that the property market had crashed and that it was not worth selling the stock. My constituents are suffering from a much lower level of health provision than if the district health authority had been able to take decisions much nearer the ground.
The opportunity to be a self-governing trust will motivate managers and professional staff better than any other proposal. Earlier in life, I had the tremendous opportunity of working in the Whitley system in Scotland.
On behalf of the Secretary of State, I received letters from all over Scotland saying, "Would it be possible, please, to readvertise the post of pharmacist in our hospital as the post of senior pharmacist, because having advertised it as pharmacist we have discovered we cannot get anybody?" The Secretary of State had to take those decisions.
Things have improved a little, but, as we all know, in a prosperous part of the country such as my constituency it is impossible to find national health service cooks because of competition from local firms. The solution being pressed on the Secretary of State by the health service unions is dramatically to upgrade the pay of cooks from John O'Groats to Lands End. That is an absurd proposition and would lead to costs escalating out of proportion to need or opportunity.
We should make it possible for local self-governing trusts so to organise their affairs that, taking account of the state of the local market, they can decide whether they will raise the salaries and wages of some staff, whether they will contract out to private firms or whether they will find another way of tackling the problem. That is good management and is what self-governing trusts are about. All the nonsense being spuriously generated by the Opposition is so much folderol that should be dismissed out of hand.

Mr. Archy Kirkwood: It was disingenuous of the hon. Member for Ealing, Acton (Sir G. Young), who unfortunately is no longer present, to say that this part of the Bill giving hospitals self-governing status was a minor devolution of responsibility and power and to compare it with GPs and how similar parts of the health service currently work. That glossed over the extent of the fundamental change that the internal market, of which self-governing hospitals are part, will make.
This is the most far-reaching and fundamental change to the health service and the administration of health care since the service was established 40 years ago. The Government cannot deny that.
I am most worried about the move towards new commercial management, financial accountability, and efficiency, because the present process of accountability, although it is an intangible part of the current system, works. It certainly works in the Borders health board area. Local patients and consumers have confidence in the accountability process because it reflects their views. The new system of management, with executive health boards, regional and district health boards and regional health authorities, squeezes much of that accountability from the current system. The Government ignore danger at their peril.
The debate has not filled me with confidence. I f the consultation process is conducted in the same way as the debate has been conducted in the House, the public will be extremely perplexed. If that analysis is correct, the Secretary of State should consider holding ballots so that he can at least control the arguments. He can ensure that the information that is made available to the public is objective on both sides of the argument.
I am against self-governing trusts, which would be inappropriate for and unpopular in the borders. If the Secretary of State is worried about political organisations and front organisations causing confusion by advancing arguments that are either distorted or untrue, by accepting the amendment for ballots he would be able to control them and ensure they are fair and are administered


properly. Ballots would inform the consultation process positively and the Government would be daft not to accept them.
If the Secretary of State leaves the consultation uncontrolled, he will get exactly what he has been evincing worries about this evening—distortions and half-truths. That would do nothing but confuse the public, which is not in anybody's interests. It is a basic tenet of democracy when dealing with something as important as the NHS that the Government should do everything possible to achieve full consultation. That must embrace the opportunity of a ballot to the results of which the Government would have to pay attention.

7 pm

Mr. Wilshire: As Opposition Members were so lacking in enthusiasm to accept interventions, before I come to the one point of substance that I wish to add to the debate, I shall say a word or two about their remarks. They need to be commented on as early as possible.
The hon. Member for Peckham (Ms. Harman) made three points which Tory Members sought to challenge, but did not get the opportunity to do so. I hope that I wrote down correctly what she said. No doubt she will put me right if I did not. First, she said that self-governing trust hospitals would seek to attract patients by cutting corners.

Ms. Harman: indicated assent.

Mr. Wilshire: I am grateful to the hon. Lady for confirming that. Once again, she made it clear that she has not the first grasp of the best way to achieve and improve quality in anything. It shows a complete poverty of thinking and a lack of understanding. I can think of no example of anybody who has a choice in buying a product or using a service choosing an inferior one. The only way to attract patients is by offering a better quality of service.

Mr. Eric Martlew: Will the hon. Gentleman give way?

Mr. Wilshire: I shall give way with the greatest pleasure, even if Labour Members do not like to do so.

Mr. Martlew: Can the hon. Gentleman not think of circumstances in which people choose according to price rather than quality? Why, for example, are there so many Lada cars running round in my constituency?

Mr. Wilshire: That is yet another example of a failure to grasp what we are talking about. We are talking only about the choice of quality of product, because the NHS is paying the bill. The patient does not have to address himself or herself to the price tag, but only to the quality of the service on offer. That is the difference. Yet again, the Labour party demonstrates its complete failure to grasp that elementary point.
Secondly, the hon. Lady, speaking on behalf of the official Opposition, said that it was against the internal market. That suggests that the Labour party has not learnt the first thing in the past 10 years. It is still saying that it is against the internal market in the health service, and therefore against choice. Despite all the wonderful rhetoric in the glossy brochures that it has has been circulating

recently, it is still peddling the view that the Labour party knows best what is good for patients and that patients cannot be trusted to make a choice.

Mr. Foulkes: We are talking about ballots.

Mr. Wilshire: I hear what the hon. Gentleman says, but I am only quoting the comments of Labour spokesmen. It was they, not me, who said that they were against the internal market.
Thirdly, the hon. Lady said that the staff want their say because they care about patients. Again, I hope that I quote her correctly.

Ms. Harman: indicated assent.

Mr. Wilshire: I am grateful to the hon. Lady for confirming that. She then elaborated on what she meant rather than what she had said, which was that the staff care about their union membership. It seems that the Labour party is anxious to ensure that people working in the NHS should have it made easy for them to belong to trade unions that care so deeply about patients that they will either organise strikes or work to rule.

Mr. Paul Boateng: If the benefits of the internal market are so obvious, why will not the hon. Gentleman allow patients to make the choice in a ballot?

Mr. Wilshire: Another problem with Opposition Members is that some of them wander in halfway through debates, having missed what has been said. The best answer to that is either to be here at the beginning or to read Hansard tomorrow morning. I most certainly will not go over that ground again.
The hon. Lady said that staff want their say because they care about patients. Then she explained that what they cared about was union membership. We were further told that they cared about national agreements. We have already made it clear that national agreements are the bane of the life of hospital managers. I know it only too well from the west London area where it is almost impossible, under the current Whitley arrangements, to attract and keep nursing staff. I address this point almost more to my right hon. and hon. Friends than to Opposition Members. If we truly believe that the best people to manage are the managers whom we appoint, we must give them control of the structures being created and of pay and conditions. We must have the courage to say that effective management means managers negotiating with their own staff. It is nonsense for managers in London to be fettered by what is happening in John o'Groats. Management must be devolved down to the hospitals.
The hon. Member for Walsall, North (Mr. Winnick), whom I am glad to see back in his place, challenged me to respond to what might happen in my constituency. I can tell him what happens there. I have not held a ballot, but a petition is going the rounds. The organisers of the petition tell me that there are 20,000 signatures on it opposing what is being suggested. I accept that the petition is not about self-governing trusts, but it will make the point and allow me to answer the hon. Gentleman's challenge. The petition suggests that my constituents are against closing two hospitals and building a new hospital in a completely inaccessible place. Clearly, they would be against that, would they not? The only snag is that the


organisers failed to tell my constituents that so far there are no details of where the new site will be. Yet 20,000 people oppose the new site because it is inaccessible.

Mr. Winnick: Obviously, I cannot comment on that local issue because I do not know the details, but no doubt there is another side to it. Would the hon. Gentleman be willing to hold a ballot about whether the hospitals in his borough should become self-governing, if the questions were approved by both sides and if the Electoral Reform Society carried it out? Would he object to such a ballot?

Mr. Wilshire: I am happy to put it on record that I should be absolutely delighted to have a ballot in my constituency; it will be called the general election. [Laughter.] To meet the hon. Gentleman's requirements, I am happy to put it on record that I shall fight the general election and put in my manifesto, as I am sure my party will, that we believe in this Bill, which will then be an Act, and in self-governing trusts. We shall put that to the electors. Last time they gave me 60 per cent. of the vote and I have little doubt that they will be enthusiastic to return me again. If the hon. Gentleman manages to be returned, he will have his answer.

Dr. John Reid: Why does not the hon. Gentleman answer the straightforward question that has now been put to him twice? He knows that general elections cover a whole range of topics. As he stressed the need for patients to choose quality, will he be prepared to give patients in his constituency the chance to choose quality by a ballot on these proposals? Yes or no?

Mr. Wilshire: My patients and electors will be given the chance to choose the quality of their present Member. That is what the democratic process is all about.
The hon. Member for Sheffield, Hillsbrough (Mr. Flannery) said that the Conservative party had voted against the national health service in the past and therefore all Conservatives are against the national health service. I was slightly more than a gleam in my father's eye when the vote to which the hon. Gentleman referred took place. No doubt he can tell me what year the vote took place, but I do not believe that I was out of my pram—[Interruption.] I am sure that some hon. Members think that I have not learnt much since. However, I should be extremely grateful if the hon. Member for Hillsborough would stop trying to suggest that because the Tory party did something some years ago, I must be in favour of transporting people who steal sheep. That is what he seemed to be arguing. I am not in favour of that.

Mr. Flannery: Sadly, the hon. Gentleman is conveying to us the impression that he has not really got out of his pram yet. The Conservative party has always been against the national health service and voted against it. The British Medical Association has had the grace to say that it has changed its mind and that it now supports the NHS. However, the Conservative party is still, by its actions, proving that it is completely against the health service.

Mr. Wilshire: The hon. Gentleman has made the other point that I wanted to make against him. Not only does he insist that, because something happened 50, 100 or 200 years ago, those of us who were not involved are, by definition, of the same mind. He has just shown that he does not understand that, and he has also claimed to be a mind reader. He suggests that he knows what the

Conservative party believes. More importantly, he tried to put words into my mouth by suggesting what I believe. I have always believed in the national health service and I am sure that I always will. I have always done everything possible to further it. It is a gross misrepresentation to suggest that an Opposition Member knows what Conservative Members think.
The hon. Member for Wakefield (Mr. Hinchliffe) would not give way either, so I must respond to him now. He said that self-governing trusts would make central planning impossible. He is yet another member of the Labour party who has failed to understand the principle of how to get quality services. He suggests that command planning from the centre is the best way to run a public service. He obviously has not learnt any lessons from what has happened in Russia or in eastern Europe over the past 12 months.
The hon. Member for Wakefield also thought that it was grossly unreasonable or, dare I say it, somehow morally wrong that his constituents should be expected on occasions to be treated in a private hospital.

Mr. Hinchliffe: It is morally wrong.

Mr. Wilshire: I am glad that that is on the record. Obviously his view of Labour policy is that it should abolish the private health service.

Mr. Hinchliffe: indicated assent.

Mr. Wilshire: I am most grateful to the hon. Gentleman for nodding. A Labour Member has now said in the House that he wants to abolish the private health sector.
I did not serve on the Standing Committee of this Bill and I have not been closely involved with it. I have no intention of going over the general ground. However, those hon. Members—including some Conservative Members—who are against self-governing trusts appear to be in favour of ringfencing. I do not want to pre-empt the ring-fencing debate, but hon. Members who are against self-governing trust hospitals, but claim to be in favour of ringfencing, are deploying a very curious train of thought.
7.15 pm
When I served on a health authority, we safeguarded community care and the community health budget, bearing in mind the fact that the great debate in the health service has always been the demands of the acute sector against the demands of community care, by ringfencing them. I understand the ringfencing argument to be about protecting community care. If Opposition Members are in favour of protecting the community budget by ringfencing it, why are they against what is in effect the ringfencing of acute district general hospitals by allowing them to become self-governing trusts? I believe that one of the greatest assets of self-governing trusts is that the remainder of the budget which is outside the acute sector is protected and care in the community is safeguarded. I should have thought that, as they support ring-fencing, self-governing trusts would appeal to Opposition Members.

Dame Elaine Kellett-Bowman: If my hon. Friend had the misfortune to live in the Lancashire county council area or to be in charge of community care there, he would find that it blows every penny that comes its way on the least important things. That council is quite different from my local health authority, which is highly efficient—[Interruption.] The two horses are of a completely


different colour. Lancashire county council is profligate, but the local health authority is very good and efficient, as are the hospitals.

Mr. Wilshire: I am sure that my hon. Friend's comments will be noted in Lancashire.
I want to challenge Opposition Members and one or two of my colleagues about ringfencing. If hon. Members are against self-governing trusts and they vote that way tonight, bearing in mind the fact that the trusts are the best way to ringfence the acute sector, I fail to see how in all conscience they can vote in favour of ringfencing something in local government. The two arguments do not hang together. I believe that Members must be consistent and I will explain later, if I catch your eye, Mr. Deputy Speaker, why ringfencing in local government would be nonsense.

Mr. Bradley: I will try to bring the debate back to the issue of opt-out. I will also be brief, because we have suffered long rambling speeches from Conservative Members. The Conservative party has tried to get as many of its Members as possible to speak to talk about specific issues that affect their constituencies.
Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I have received hundreds of representations from my constituents opposing the proposals for opt-out. I have not received one letter in favour. That is particularly significant, because the world-famous Christie hospital is in my constituency. Local people are very proud of that hospital and they have raised thousands of pounds for it. I strongly believe that Christie hospital is at the top of the list of hospitals which the Government want to see opt-out as soon as the Bill becomes an Act.
We must consider what has been happening to the opt-out proposals during the Bill's passage through the House, and in that context I want to refer to Christie hospital. The management of Christie, at a very early stage, expressed an interest in opting out. However, the management only consulted some consultants in the hospital.
The Secretary of State said tonight that he does not believe that the consultants should be the sole custodians of views about whether a hospital should opt out and that there should be more consultations with staff. In Christie, no other staff were consulted. Similarly, the local community and local representatives such as the community health council were not consulted. The issue was not even drawn to the attention of South Manchester health authority because the authority did not believe that it should have a say in whether the hospital should have expressed an interest.
It is absolutely clear that hospitals are seeking opt-out status because of the financial crisis in many health authorities. The financial crisis facing south Manchester health authority is the reason why Christie hospital is expressing an interest in opting out.
The Secretary of State recently crept into south Manchester to look at what was going on. The headlines in the local paper stated that all that the people of south Manchester ever did was moan about the state of the health service. Well, they have plenty to moan about. In the last few years, we have had ward closure after ward closure; waiting lists have been growing and staff have not

been recruited because of lack of money. Now, Christie hospital has admitted for the first time that it cannot open a crucial ward because of lack of money. As the Secretary of State has said, the unit manager of the Christie hospital is the local enthusiast—he is the only local enthusiast—who has put forward proposals for opting out. He admitted in an article in the local health paper that
a Unit such as Christie with potential for growth and development of cancer services must recognise that for the foreseeable future there will be no growth monies available from Regional funds. From April 1990 the budget of the North West Region begins to reduce and this will inevitably mean that already hard pressed district Health Authorities"—
such as south Manchester—
will encounter further financial problems".
That is why the hospital is going down the road of opting out.
The consultants are fed up with the lack of resources. They are prepared to go along with the proposals as long as they believe—as I do—that the first hospitals to opt out will be stuffed full of money by the Government to show that such hospitals can be successful. I believe that the Government will go forward to the next general election on that basis.
For its "consultation", the management has produced a glossy magazine—

Mr. James Pawsey: rose—

Mr. Bradley: No, I shall not give way.

Mr. Pawsey: rose—

Mr. Bradley: I shall not give way to the hon. Gentleman, because he has only just walked into the Chamber.
The management has produced a glossy new magazine to try to justify its opting out, which states:
we would still be required to treat a similar number of patients, but we would have no guaranteed funding because the service contracts would be held by South Manchester Health Authority.
That is what the management have told the staff. However, in a written answer the Under-Secretary of State for Health has stated that, whether the contract is held by the NHS trust or by the directly managed hospital in south Manchester, the money will go to the hospital where the patient has been treated. Therefore, the management are not telling its staff the truth about the way in which the funds from the contract will be allocated.
The management then ask how they should continue the consultation process. As I have said, they have already drawn up a document, which they are ready to throw at the Secretary of State at the first opportunity, which states that the staff should try to borrow a copy of the document from the administrator so that they may know what is going on. They can then attend a series of public meetings at which only the general manager will be allowed to speak. Instead of having a show of hands at the end of the meetings to determine the views of the staff in the hospital, the general manager himself will assess the consensus and judge the feeling of those in the room. The general manager—the local, the only, enthusiast—will determine whether to submit a formal application.
That is the way in which consultation is taking place, and that is why we in south Manchester say, on behalf of Christie hospital, that we want a ballot. We want the staff to be able to express their view. We cannot believe that the Government are not prepared to accept the idea of ballot,


which is what they argued for in education and housing. The hon. Member for Ealing, Acton (Sir G. Young) said that he does not support ballots on the opt-out of hospitals, because where there have been ballots on, for example, education and housing, they have proved popular.
I ask the House to consider whether one single school has opted out in Manchester. Has a single council house moved to the control of a private landlord? The answer is no, because people in Manchester know the value of the public sector and of public provision. They know the value of local accountability for those services. That is why the people of south Manchester want hospitals that are directly managed by local people, which are locally accountable and which are properly funded within the public sector.

Mr. Quentin Davies: It was not my original intention to speak at this point. However, I feel that I must do so to give the hon. Member for Peckham (Ms. Harman) some assistance in a vital matter. All of us who know the hon. Lady know that she would not have the slightest intention of deliberately deceiving the House, but I fear that if an important passage in her speech at the beginning of the debate stands without correction, she may succeed in deceiving the House, albeit unwittingly and by strong implication rather than explicit statement.
When the hon. Lady was talking about ballots, which are the central issue of the debate, she said that, notwithstanding the extremely compelling technical reasons against holding ballots to determine public opinion about the proposed changes in the administrative arrangements for hospitals, it is right and reasonable that such ballots should take place. When she dealt with the sensible if obvious point that in 1948 the Labour Government did not introduce any specific ballots on their own administrative arrangements for hospitals, which were contained in the National Health Service Act 1946, she replied. "Ah, but the difference is that at that time we had had a general election."
The clear implication of the hon. Lady's statement was that there had not merely been a general election, which there had been in 1945 and which the Labour party won—just as we won the election three years ago—but that, in its manifesto or otherwise, the Labour party had made clear its proposals for the administrative arrangements for hospitals that it would incorporate into any national health service Bill that it might introduce. The hon. Lady implied that when the public went to the booths in the election of 1945, they knew exactly what administrative arrangements for hospitals they were voting for. She suggested that that was unlike what happened with the Conservative in 1987.
In case any hon. Member has forgotten, I remind the House that no such thing occurred. The Labour party's 1945 manifesto did not make any reference to the administrative arrangements that it was proposing to introduce for hospitals. Indeed, no statement on that subject was made during the whole of the campaign that summer. That was for the very good reason—this is why I can be dogmatic on the point—that, at that stage, the Labour party itself had not decided on the administrative arrangements.

Dame Elaine Kellett-Bowman: Does my hon. Friend accept that Christie hospital does not belong to its staff? It belongs to the people of the north-west and it would be extremely difficult to ballot all those people. I must advise the House that in some specialties, 49 per cent. of the patients dealt with by my local health authority are out of district, mostly from Cumbria. On average, it is 29 per cent., but the proportion is 49 per cent. for some specialties. Who exactly does the Labour party expect us to ballot? It is not possible to find a constituency to ballot on these things, although that is what Opposition Members are suggesting.

Mr. Davies: I agree entirely with my hon. Friend's helpful comment. There are strong reasons for not having ballots, and no doubt Labour was right in 1948 in not holding specific ballots on that issue.
The hon. Member for Peckham suggested that there was no need for ballots, not because technically they are not feasible or were otherwise undesirable, as my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) suggested, but because the public already knew in 1948 what the arrangements would be and voted accordingly.

Mr. Robert Litherland: Will the hon. Gentleman give way?

Mr. Davies: No. I am sure that the hon. Gentleman will be able to catch your eye later, Mr. Deputy Speaker.
The truth is quite contrary to the hon. Lady's argument. When the electorate went to the polls in 1945, it had every reason to suppose that whichever Government was elected—Conservative or Labour—they would introduce a national health service along the lines of the Willink White Paper of 1944. I was not alive at the time, but I am sure that you, Mr. Deputy Speaker, will remember as though it were yesterday that when that White Paper was produced by the then coalition Government, it set out a plan for the health service that contained almost all the features that were eventually incorporated in the Labour Government's national health service in 1948, with one vital difference, in that the Willink White Paper did not propose hospital nationalisation. In 1945, without giving any warning to the electorate, Labour introduced the nationalisation of hospitals, with none of the specific ballots that, according to the hon. Member for Peckham, it would have been reasonable to expect Labour to hold.
I could make a powerful political point, because the facts I have set out could explode the sincerity of all that has been said about ballots by Labour Members this evening. However, there was a more positive reason why I rose to speak. It was to help maintain the integrity of the debate by giving the hon. Member for Peckham an opportunity to set the record straight and to make it clear that there is no difference between the attitude towards ballots taken by Labour in 1948 and that of the Conservative party in 1990.

Mr. Redmond: The majority of people in the Doncaster health authority area are totally opposed to the opting out that is supported by a small minority. The Secretary of State continues to display arrogance and conceit. He ought to be present, because I do not want to say anything behind his back. I welcome the Secretary of State back to


his place, and repeat that his arrogance and conceit continue. Thank God, people fought to get rid of that kind of dictatorship during the second world war. They will fight again to do so.
If the Secretary of State is so convinced that he is right, the simple answer is for him to ballot the people. If he wants to be doubly sure, why does not the right hon. and learned Gentleman convince his master to call a general election? I am convinced that the vast majority of people are wholly opposed to the Government's reforms for a two-tier system, which will lead to privatisation.
The Secretary of State condemns local authorities that utilise local money to sound out people's opinions. Doncaster is Labour-controlled, but it not only stated its opposition to the reforms—which the Secretary of State might argue was party political propaganda—but consulted local people. The Secretary of State says, in effect, that consultation may take place but that he will ignore it.
The pity is that the Secretary of State did not spend the millions of pounds used to promote his views and to hold meetings throughout the country with unit managers and other interested parties on consulting the public, which would have been a far better use of that money. The Secretary of State spent millions promoting his voice and his master's voice against local authorities who spent a few pounds. He ought to be interested in freedom and democracy. The iron curtain has gone, but the dictatorship that used to exist behind it now exists in this country. The Government use the phrase "the enemy within", but the enemy within now are Conservative policies that seek to undermine our social fabric.
Whom will the Secretary of State consult? What criteria will he set and how will a local authority determine whether its application to opt out meets them? The right hon. Gentleman said that he will ignore consultants and any other group that consults its members or holds a ballot and then opposes the reforms. That is the kind of dictatorship and arrogance that he uses to bulldoze opposition.
The Government imposed a guillotine on this important debate, and now Ministers intervene time and again. If the Secretary of State wanted to explain his policies, the Government should not have guillotined debate but fully utilised the time available to explain their proposals. The right hon. and learned Gentleman has failed to convince the majority of the public.
The newly appointed chairman of Doncaster health authority, the newly appointed unit manager and the newly appointed district nursing officer all support opting out. They are the people that the Secretary of State has connived to put in place so that he may claim that Doncaster supports his proposals, when that is false. If the Secretary of State wants to be true to himself, he should return to the Dispatch Box and announce that he is withdrawing this ludicrous and uncaring Bill.

Mr. Jim Cousins: In the northern region, the dwindling list of hospitals that want to opt out is down to five, and they are located in the city of Newcastle. The opting out and trust proposals that would affect the citizens of Darlington and Tynemouth, which are among the shrinking band of Tory seats in the northern region, have also been dropped. That is an

interesting sign that the Government are not confident about the little lifeboat that they have launched for the national health service.
We in Newcastle are confronted with opting out by all four of the city's major hospitals, but we are told by the Secretary of State that they do not anyway belong to us, as patients or as citizens—yet he is apparently content for them to belong to a small band of self-appointed people. No one knows who they are or what credentials they have. He is happy about that. As the proposals for NHS trusts are tested, the credentials of the people who lend their names to those trusts will be closely tested.
The Secretary of State, in one of his throwaway remarks that will come back to haunt him, described local councils as a bunch of bandits. We suspect that that description far better suits the type of people who will self-recruit, self-appoint and keep the NHS trusts in their pockets for ever.
My hon. Friend the Member for Peckham (Ms. Harman) was absolutely right to highlight the process that is going on in Newcastle in the four hospitals that are the subject of opt-out proposals. She said that there is a whispering campaign of bribery and blackmail and that promises of promotion, pay increases and extra resources for particular facilities are being made to grease the wheels and smooth the process of opting out. We must have ballots so that such below-the-line rumours and whispering are forced above the line so that they are on the record and publicly known.
I note that the ministerial team are furiously engaged in a discussion about this matter. The unit general manager in Newcastle may be promising a Westminster or a Wandsworth to the people who work in those hospitals, but it is much more likely that the Minister will be gifting them something more like a west Lambeth. Promises to run those hospitals on Westminster or Wandsworth lines will prove to be a mirage; west Lambeth will be the reality. That is not good enough. Such major proposals cannot be forced through on the basis of false promises.
The Government's proposals are fundamentally wrong because of the false expectations that they are arousing in some people's minds. The proposals will be undone not by anything that we do in this House tonight, but by what the Secretary of State does or fails to do. If people proceed with the trusts, they will find that they have been cheated. Those people, above all, will remember the proposals with regret.
My hon. Friend the Member for Livingston (Mr. Cook) said that we shall fight against the proposals as though we were fighting a by-election. I understand what my hon Friend means, but by-elections have a date at which they must terminate. In cities such as Newcastle we shall not fight against the proposals in that way; we shall persist with the scrutiny with rigour and record all the promises, the whispers and the rumours. We shall never forget them.
The hon. Member for Spelthorne (Mr. Wilshire) is apparently willing to say to nurses in west London that if NHS trusts are accepted they will be free of the NHS pay scale and paid more. With what? Do the Government propose to issue some kind of NHS junk bond with which to pay the money? The answer is no.
All those false promises will be placed on the record. It is much better to force such a corrupt and unacceptable method of doing public business into the open so that such practices can be properly recorded. Whether or not the Government decide to do that, the job will be done. Such


practices will be recorded and will not be forgotten. They will bounce back again and again in the lifetime of the Government.

Mr. Fatchett: I agree with what my hon. Friend the Member for Newcastle upon Tyne, Central (Mr. Cousins) said in his excellent speech.
During the debate, one Conservative Member after another—when the Government have found it possible to get people into the Chamber to support the Bill—has said that the opt-out proposals are self evidently popular. They have said that there is no argument about the nature and potential success of opt-out hospitals. If that is so, why are Conservative Members so afraid to put that proposal to the electorate so that the people can have a voice? They are running away from the issue.
The Secretary of State told us that the enthusiasm for the proposals would come from a small group of independent-minded people, some of whom would be local business people with or without experience of the NHS. The Secretary of State has now invented another category of person capable of running the NHS with his approval—someone with no experience of it, that is to say, someone who has spent all his life as a patient of the private sector and who supports it. That is the person who the Secretary of State believes is capable of running the NHS. We do not want such self-appointed people running the NHS, but those who represent the public and who are concerned about the NHS and have its interests at heart.
7.45 pm
The Secretary of State has tried to be emollient and I know that that is difficult for him. I understand why the chairman of the Conservative party said that the right hon. and learned Gentleman needed some advice on public relations. In his attempt to be emollient, the right hon. and learned Gentleman said that he would consult and listen, but at no point in his speech did he tell us what the test would be before he said no to a particular trust proposal. The answer is simple—if the proposal is backed by a small group of Conservative party supporters and Conservative central office wants it, it will go through.
Let us consider a local example dear to my heart and to that of the people of Leeds—St. James's hospital, now nationally known as Jimmy's after the television programme. What will happen to that hospital? What test would the Secretary of State use to determine whether that hospital should opt out? The health authority, the consultants, the community health council, the nonmedical staff and the public of Leeds have said no to that hospital opting out, so on what moral grounds could the Secretary of State approve a decision to allow it to opt out? Yet as there is a Conservative party nominee in the chair of the health authority and the unit manager is a close advisor of the Secretary of State, I suspect that there is no question but that the decision on that hospital opting out will go ahead roughshod without any reference to public opinion.
My hon. Friend the Member for Peckham (Ms. Harman) spoke of bribes and blackmail. It is interesting to consider what has happened in Leeds Western health authority in relation to the general infirmary. The district general manager, without the approval of the health authority, appointed an outside consultant to write a report on the future of the general infirmary. That report was commissioned and paid for by one of the key

ideological advocates of the opt-out proposals. The report's sole conclusion was—surprise, surprise—that it would be in the interests of the general infirmary to achieve opt-out status. The report also stated that, if the hospital continued in its current state, with its current fabric, it would not be fit to be judged a modern hospital. Rumour after rumour has come from the chairman of the authority and the district general manager. That has been passed on to the consultants, the staff and the public. The message is clear: "If you do not opt out, the money for phases 1 and 2 of the general infirmary will not be forthcoming". Those are the tactics of the bully boys who have gone into the gutter in desperation to force their proposals through.
The obvious conclusion from the debate is that the Conservatives have no confidence in their proposals. They are driving them through for pure ideological reasons, and that will be part of their down fall. We look forward to campaigning on this issue, because we know that we speak for the public on the NHS.

Mr. Foulkes: I shall take just a couple of minutes to show from our experience in Ayrshire that the Government's proposals represent one of the biggest cons ever perpetrated on the British people.
The chairman of the health board confirmed in December that throughout Ayrshire there was no interest in opting out. The Under-Secretary of State for Scotland, one of the ideologues of the Government, could not stand that, so he instructed the health board to manufacture an interest. The administrator in north Ayrshire was against the proposal and said that there was no interest. What happened to him? He was moved sideways to a position where he had no influence.
The administrator in south Ayrshire decided to go along with the health board. He used bribery, saying that phase 1 of the hospital will come about more easily under NHS trust status, and the hospital agreed to consider it. The consultants voted on it and, as 89 per cent. of them were against opting out, they decided not to consider it. In spite of that, the unit administrator went ahead with the proposals and a working party has now been set up to look into the possibility of opting out. The Scottish Office is paying for consultants to carry out a business plan. That demonstrates the way in which they are considering the proposal. It is not a care plan or a feasibility study, but a business plan.
We know what will happen next. That business plan, which will be prepared by the end of August without any of the necessary information being available, will be accepted by the health board nominated by the Tory Ministers. They will agree to that plan and put it up to the Secretary of State and of course he will accept it. There is no demand for it in Ayrshire, yet it will be forced on the people of Ayrshire. It is absolutely clear that, if there were a ballot, the people of Ayrshire and Arran would reject it overwhelmingly. That is why all Opposition Members who represent Ayrshire constituencies support the amendments to the Lords amendments. Although we support such ballots, one ballot that would end all such proposals once and for all—and we would much rather have that ballot as quickly as possible—is a general election.

Mr. Kenneth Clarke: We have had a long and rather animated debate on a proposal that we have discussed many times before. Those who may be listening to our heated exchanges might be surprised to reflect on the fact


that the Government amendments moved in the Lords, which I suggest we agree to, are hardly controversial. They were tabled in support of the proposal that we have been advocating from the beginning—that there should be widespread consultation on all applications for NHS trusts. We are now putting that consultation in statutory form. I hope that the debate might have served to educate people more generally about exactly what we shall be consulting on. However, public consultation cannot possibly start until we have promoters in Ayrshire, Doncaster or wherever, coming forward and explaining their proposals for the hospitals for which they are responsible. Then people can give sensible and considered views.
The amendments that I am resisting concern ballots, about which the Labour party has made repeated claims for the past six months or so. I shall not repeat my arguments, but I believe that the Labour party, which is stuck for ideas on what to propose, prefers political campaigning on local ballots based on fears about our proposals. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) was correct to describe the nature of most of the ballots that have taken place so far. It is extraordinary to compare such ballots with the ordinary electoral process, as there are no promoters and no definite proposals. Nobody will be arguing the case for local NHS trusts until we receive the applications next month.
However, in various localities people have produced the most extraordinary claims about what they suppose NHS trust status will mean in their localities. They have talked about hospitals opting out of the national health service. We heard that a pensioner in Doncaster was persuaded that sandbags were needed to defend the national health service against Tory assault. The hon. Member for Sheffield, Hillsborough (Mr. Flannery) kept going back to the vote in 1948 which was one of the most galling exchanges on health service policy that I have heard for a long time.
Such ballots produce a sort of Romanian election result if no one is proposing anything or arguing the case for NHS trusts and there are no propositions to consider. All we have is sometimes a highly financed and organised campaign against a non-existent proposition. Proceeding in that way can achieve a 9:1 result against what it is suggested will happen.
We are about to move on to genuine consultation, but first we need some NHS trust applications and some descriptions by the promoters of what is proposed for hospitals in each locality.

Mr. Max Madden: When I called for ballots of staff and patients in Bradford, I was told by Ministers that the main reason why ballots were opposed was that the issues surrounding self-governing trusts were too complicated and complex to be considered in ballots. When all the information is known, will the Secretary of State accept in principle the offer of ballots for staff and patients to decide those important issues? Bearing in mind that we had a referendum on whether to remain in the EEC and that the Government have held ballots on schools and housing, why on earth are they continuing to resist ballots on the national health service?

Mr. Clarke: When the proposals are produced, it will be clear that they are complex matters concerning the future of each part of the service, how each part of the service might be developed and how financial management and other matters will be arranged. It would be ludicrous to reduce them to a yes/no answer. I have repeatedly said that the national health service does not belong to the staff who happen to be in post, so a straight staff ballot should not decide those issues. The problem of having a ballot of patients is that there is no catchment area of patients for each hospital. Hospitals are not run on that basis and there is no identifiable group of the population who could sensibly be balloted, assuming that one could find enough people to absorb all the proposals.
When applications come in, there will be no simple response to any of the proposals, even among the consulting staff, the nursing staff and everyone else who supports the health service. Many people will want to make suggestions concerning particular aspects of the service, and I hope that that public consultation at local level will not be damaged by the Labour party's clear intention to turn every application into a simplified by-election.
Let me deal briefly with the comments made about the internal market by the hon. Members for Peckham (Ms. Harman) and for Roxburgh and Berwickshire (Mr. Kirkwood). The phrase, "internal market" is jargon that leads people into arguments about commercialisation and so on. It is quite convenient jargon, but it is always misused. It is not true that the proposal for NHS trusts has anything to do with the internal market. The basis of distributing the money in future according to so-called contracts, agreements between the planners and purchasers on the one hand and the providers of care on the other will apply to all hospitals and all units regardless of whether they are self-governing NHS trusts. The NHS trusts will look for referrals and their revenue in the same way as other hospitals do. We are talking about the extent to which, within the new system, self-governing trusts will have their own local board of management and will not be answerable to the district, the region, my civil servants and to me for day-to-day matters, compared with others that will still remain subject to the DHA.
I regret that the hon. Member for Peckham said that the Labour party is against those aspects of the reforms. She tried to make the position clear, as the Labour party never has before. I refer her to the article that appeared a couple of days ago written by Chris Ham, who has been one of the more reluctant supporters of my reforms. He does not suggest them all; he does not support self-governing hospitals. The last time that I said he was a Marxist he corrected me and said that he was not a Marxist, although he writes for Marxism Today. However, he has supported most of the White Paper proposals, because he takes the view that although he is obviously far to the left of me, he believes in well-managed public services that strive for the same levels of efficiency and public responsiveness as the best of the private sector. As someone who in on the left, he firmly believes that a public service such as the NHS is capable of being at least as well run and responsive as the private sector. I share his view. We are striving to bring the NHS up to the levels of performance achieved by private sector organisations delivering less important services.
In his latest article, Chris Ham yet again particularly commended the division between those in the health authorities who work out the population's health needs


and seek to use the money available to procure the provision of health in line with need, and those who have to provide those services. It would be a disaster if the Labour party, for purely populist reasons, were incapable of taking on board the best aspects of the reforms.
8 pm
National pay has been mentioned. I wholly agree with what my hon. Friends the Members for Spelthorne (Mr. Wilshire) and for Mid-Kent (Mr. Rowe) said about reactions to the proposals in their districts and the way in which they rightly said that running through many Labour Members' speeches was what they actually fear about self-governing hospitals. Much of the argument about NHS trusts is bogus—for example, that people think that opting out of the NHS is the same as privatisation. I have difficulty in being persuaded that even passionate Labour Members seriously believe a word of that.
What makes some people in the service excited—from the British Medical Association, through the Trades Union Congress affiliates to the Labour party—is that they see national pay, terms and conditions being changed. The staff should not see that as a threat; it was rightly welcomed by my hon. Friends. Contrary to them, the hon. Member for Peckham gets passionate about defending Whitley council arrangements, national trade union recognition arrangements and other factors that stop the management having any discretion locally about how they recruit and reward their staff.
My hon. Friend the Member for Ealing, Acton (Sir G. Young) began our debate by making one of the best defences of the concept of local, responsible management in our national health service that I have heard for a long time. I commend what he said. We shall be consulting about the proposals for the next three months and more. I commend the amendments made in another place that will pave the way for the public consultation that we have always promised.

Question put and agreed to.

Lords amendment: No. 2, in page 6, line 14, at end insert—
(1A) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in England, he shall direct the relevant Regional Health Authority to consult, with respect to the proposal to establish the trust,—

(a) the relevant Community Health Council and such other persons or bodies as may be specified in the direction; and
(b) such other persons or bodies as the Authority considers appropriate;

and, within such period (if any) as the Secretary of State may determine, the relevant Regional Health Authority shall report the results of those consultations to the Secretary of State.
(1B) In any case where the Secretary of State is considering whether to make an order under subsection (1) above establishing an NHS trust and the hospital, establishment or facility concerned is or is to be situated in Wales, he shall consult the relevant Community Health Council and such other persons and bodies as he considers appropriate.
(1C) In subsections (1A) and (1B) above—

(a) any reference to the relevant Regional Health Authority is a reference to that Authority in whose region the hospital, establishment or other facility concerned is, or is to be, situated; and
(b) any reference to the relevant Community Health Council is a reference to the Council for the district,

or part of the district, in which that hospital, establishment or other facility is, or is to be, situated."

Read a Second time.

Amendment proposed to the Lords amendment: (c), in subsection (1A), at end add
'who shall not make an order under subsection (1) above, unless those consultations establish substantial support for an NHS trust among the staff of the hospital, establishment or facility and the local community it serves.'.—[Ms. Harman.]

Question put, That the amendment to the Lords amendment be made:—

The House divided: Ayes 210, Noes 295.

Division No. 268]
[8.2 pm


AYES


Adams, Allen (Paisley N)
Ewing, Mrs Margaret (Moray)


Allen, Graham
Fatchett, Derek


Alton, David
Faulds, Andrew


Anderson, Donald
Fearn, Ronald


Archer, Rt Hon Peter
Field, Frank (Birkenhead)


Armstrong, Hilary
Fields, Terry (L'pool B G'n)


Ashley, Rt Hon Jack
Fisher, Mark


Ashton, Joe
Flannery, Martin


Banks, Tony (Newham NW)
Flynn, Paul


Barnes, Harry (Derbyshire NE)
Foot, Rt Hon Michael


Barnes, Mrs Rosie (Greenwich)
Foster, Derek


Barron, Kevin
Foulkes, George


Beckett, Margaret
Fraser, John


Bell, Stuart
Fyfe, Maria


Benn, Rt Hon Tony
Galloway, George


Bennett, A. F. (D'nt'n &amp; R'dish)
Garrett, Ted (Wallsend)


Bermingham, Gerald
Gilbert, Rt Hon Dr John


Bidwell, Sydney
Godman, Dr Norman A.


Blair, Tony
Golding, Mrs Llin


Blunkett, David
Gould, Bryan


Boateng, Paul
Graham, Thomas


Boyes, Roland
Grant, Bernie (Tottenham)


Bradley, Keith
Griffiths, Win (Bridgend)


Brown, Nicholas (Newcastle E)
Grocott, Bruce


Bruce, Malcolm (Gordon)
Hardy, Peter


Buchan, Norman
Harman, Ms Harriet


Buckley, George J.
Haynes, Frank


Caborn, Richard
Heal, Mrs Sylvia


Callaghan, Jim
Henderson, Doug


Campbell, Menzies (Fife NE)
Hinchliffe, David


Campbell, Ron (Blyth Valley)
Hoey, Ms Kate (Vauxhall)


Campbell-Savours, D. N.
Hood, Jimmy


Canavan, Dennis
Howarth, George (Knowsley N)


Carlile, Alex (Mont'g)
Howell, Rt Hon D. (S'heath)


Clark, Dr David (S Shields)
Howells, Geraint


Clarke, Tom (Monklands W)
Howells, Dr. Kim (Pontypridd)


Clay, Bob
Hoyle, Doug


Clwyd, Mrs Ann
Hughes, John (Coventry NE)


Coleman, Donald
Hughes, Robert (Aberdeen N)


Cook, Frank (Stockton N)
Hughes, Simon (Southwark)


Cook, Robin (Livingston)
Illsley, Eric


Corbyn, Jeremy
Ingram, Adam


Cousins, Jim
Janner, Greville


Cox, Tom
Johnston, Sir Russell


Crowther, Stan
Jones, Barry (Alyn &amp; Deeside)


Cryer, Bob
Jones, Ieuan (Ynys Môn)


Cummings, John
Kaufman, Rt Hon Gerald


Cunliffe, Lawrence
Kennedy, Charles


Cunningham, Dr John
Kilfedder, James


Dalyell, Tam
Kirkwood, Archy


Darling, Alistair
Lambie, David


Davies, Rt Hon Denzil (Llanelli)
Lamond, James


Davis, David (Boothferry)
Leadbitter, Ted


Davis, Terry (B'ham Hodge H'l)
Leighton, Ron


Dewar, Donald
Lewis, Terry


Dixon, Don
Litherland, Robert


Dobson, Frank
Livingstone, Ken


Duffy, A. E. P.
Lloyd, Tony (Stretford)


Dunnachie, Jimmy
Lofthouse, Geoffrey


Dunwoody, Hon Mrs Gwyneth
Loyden, Eddie


Evans, John (St Helens N)
McAllion, John


Ewing, Harry (Falkirk E)
McAvoy, Thomas






Macdonald, Calum A.
Rooker, Jeff


McKelvey, William
Ross, Ernie (Dundee W)


McLeish, Henry
Ross, William (Londonderry E)


McNamara, Kevin
Rowlands, Ted


Madden, Max
Salmond, Alex


Mahon, Mrs Alice
Sheerman, Barry


Marek, Dr John
Sheldon, Rt Hon Robert


Marshall, Jim (Leicester S)
Shore, Rt Hon Peter


Martin, Michael J. (Springburn)
Short, Clare


Martlew, Eric
Sillars, Jim


Maxton, John
Skinner, Dennis


Meacher, Michael
Smith, Andrew (Oxford E)


Meale, Alan
Smith, C. (Isl'ton &amp; F'bury)


Michael, Alun
Smith, Rt Hon J. (Monk'ds E)


Michie, Bill (Sheffield Heeley)
Spearing, Nigel


Michie, Mrs Ray (Arg'l &amp; Bute)
Steel, Rt Hon Sir David


Molyneaux, Rt Hon James
Steinberg, Gerry


Moonie, Dr Lewis
Stott, Roger


Morgan, Rhodri
Strang, Gavin


Morley, Elliot
Straw, Jack


Morris, Rt Hon A. (W'shawe)
Taylor, Mrs Ann (Dewsbury)


Morris, Rt Hon J. (Aberavon)
Taylor, Matthew (Truro)


Morris, M (N'hampton S)
Thomas, Dr Dafydd Elis


Mowlam, Marjorie
Thompson, Jack (Wansbeck)


Mullin, Chris
Turner, Dennis


Nellist, Dave
Vaz, Keith


Oakes, Rt Hon Gordon
Wallace, James


O'Brien, William
Walley, Joan


O'Neill, Martin
Wareing, Robert N.


Orme, Rt Hon Stanley
Watson, Mike (Glasgow, C)


Parry, Robert
Welsh, Andrew (Angus E)


Patchett, Terry
Welsh, Michael (Doncaster N)


Pendry, Tom
Wigley, Dafydd


Pike, Peter L.
Williams, Rt Hon Alan


Powell, Ray (Ogmore)
Williams, Alan W. (Carm'then)


Primarolo, Dawn
Wilson, Brian


Quin, Ms Joyce
Winnick, David


Randall, Stuart
Wise, Mrs Audrey


Redmond, Martin
Worthington, Tony


Rees, Rt Hon Merlyn
Wray, Jimmy


Reid, Dr John
Young, David (Bolton SE)


Richardson, Jo



Robertson, George
Tellers for the Ayes:


Robinson, Geoffrey
Mr. Martyn Jones and


Rogers, Allan
Mr. Ken Eastham.




NOES


Adley, Robert
Brazier, Julian


Alexander, Richard
Bright, Graham


Alison, Rt Hon Michael
Brown, Michael (Brigg &amp; CI't's)


Allason, Rupert
Bruce, Ian (Dorset South)


Amess, David
Buchanan-Smith, Rt Hon Alick


Arnold, Jacques (Gravesham)
Burns, Simon


Arnold, Sir Thomas
Butcher, John


Ashby, David
Butler, Chris


Atkins, Robert
Carlisle, John, (Luton N)


Atkinson, David
Carlisle, Kenneth (Lincoln)


Baker, Rt Hon K. (Mole Valley)
Carrington, Matthew


Baker, Nicholas (Dorset N)
Carttiss, Michael


Baldry, Tony
Cash, William


Banks, Robert (Harrogate)
Chalker, Rt Hon Mrs Lynda


Batiste, Spencer
Chapman, Sydney


Bellingham, Henry
Chope, Christopher


Bendall, Vivian
Clark, Dr Michael (Rochford)


Bennett, Nicholas (Pembroke)
Clark, Sir W. (Croydon S)


Benyon, W.
Clarke, Rt Hon K. (Rushcliffe)


Bevan, David Gilroy
Colvin, Michael


Blackburn, Dr John G.
Conway, Derek


Blaker, Rt Hon Sir Peter
Coombs, Simon (Swindon)


Body, Sir Richard
Couchman, James


Bonsor, Sir Nicholas
Critchley, Julian


Boscawen, Hon Robert
Davies, Q. (Stamf'd &amp; Spald'g)


Boswell, Tim
Davis, David (Boothferry)


Bottomley, Peter
Day, Stephen


Bottomley, Mrs Virginia
Devlin, Tim


Bowden, A (Brighton K'pto'n)
Dickens, Geoffrey


Bowis, John
Dicks, Terry


Boyson, Rt Hon Dr Sir Rhodes
Dorrell, Stephen


Braine, Rt Hon Sir Bernard
Douglas-Hamilton, Lord James


Brandon-Bravo, Martin
Dover, Den





Dunn, Bob
Knapman, Roger


Durant, Tony
Knight, Greg (Derby North)


Dykes, Hugh
Knight, Dame Jill (Edgbaston)


Emery, Sir Peter
Knowles, Michael


Evans, David (Welwyn Hatf'd)
Knox, David


Evennett, David
Lamont, Rt Hon Norman


Fairbairn, Sir Nicholas
Lang, Ian


Fallon, Michael
Latham, Michael


Farr, Sir John
Lawson, Rt Hon Nigel


Favell, Tony
Lee, John (Pendle)


Fenner, Dame Peggy
Leigh, Edward (Gainsbor'gh)


Field, Barry (Isle of Wight)
Lennox-Boyd, Hon Mark


Finsberg, Sir Geoffrey
Lester, Jim (Broxtowe)


Fishburn, John Dudley
Lilley, Peter


Forman, Nigel
Lloyd, Sir Ian (Havant)


Forsyth, Michael (Stirling)
Lloyd, Peter (Fareham)


Forth, Eric
Lord, Michael


Fowler, Rt Hon Sir Norman
Macfarlane, Sir Neil


Fox, Sir Marcus
MacGregor, Rt Hon John


Franks, Cecil
Maclean, David


Freeman, Roger
McLoughlin, Patrick


French, Douglas
McNair-Wilson, Sir Michael


Gale, Roger
McNair-Wilson, Sir Patrick


Gardiner, George
Madel, David


Garel-Jones, Tristan
Malins, Humfrey


Gill, Christopher
Mans, Keith


Goodhart, Sir Philip
Maples, John


Goodlad, Alastair
Marland, Paul


Goodson-Wickes, Dr Charles
Marlow, Tony


Gorman, Mrs Teresa
Marshall, John (Hendon S)


Gow, Ian
Marshall, Sir Michael (Arundel)


Grant, Sir Anthony (CambsSW)
Martin, David (Portsmouth S)


Greenway, Harry (Ealing N)
Maude, Hon Francis


Greenway, John (Ryedale)
Maxwell-Hyslop, Robin


Gregory, Conal
Mayhew, Rt Hon Sir Patrick


Griffiths, Sir Eldon (Bury St E')
Mellor, David


Griffiths, Peter (Portsmouth N)
Meyer, Sir Anthony


Grist, Ian
Miller, Sir Hal


Ground, Patrick
Mills, Iain


Grylls, Michael
Miscampbell, Norman


Hague, William
Mitchell, Andrew (Gedling)


Hamilton, Neil (Tatton)
Mitchell, Sir David


Hampson, Dr Keith
Moate, Roger


Hanley, Jeremy
Monro, Sir Hector


Hannam, John
Montgomery, Sir Fergus


Hargreaves, A. (B'ham H'll Gr')
Moore, Rt Hon John


Hargreaves, Ken (Hyndburn)
Morrison, Sir Charles


Harris, David
Morrison, Rt Hon P (Chester)


Haselhurst, Alan
Moynihan, Hon Colin


Hayes, Jerry
Neale, Gerrard


Hayward, Robert
Newton, Rt Hon Tony


Heathcoat-Amory, David
Nicholls, Patrick


Hicks, Mrs Maureen (Wolv' NE)
Nicholson, David (Taunton)


Hicks, Robert (Cornwall SE)
Nicholson, Emma (Devon West)


Hill, James
Norris, Steve


Hind, Kenneth
Onslow, Rt Hon Cranley


Hogg, Hon Douglas (Gr'th'm)
Oppenheim, Phillip


Holt, Richard
Page, Richard


Hordern, Sir Peter
Paice, James


Howard, Rt Hon Michael
Parkinson, Rt Hon Cecil


Howarth, Alan (Strat'd-on-A)
Patnick, Irvine


Howarth, G. (Cannock &amp; B'wd)
Patten, Rt Hon John


Howell, Rt Hon David (G'dford)
Pattie, Rt Hon Sir Geoffrey


Howell, Ralph (North Norfolk)
Pawsey, James


Hughes, Robert G. (Harrow W)
Peacock, Mrs Elizabeth


Hunt, David (Wirral W)
Porter, Barry (Wirral S)


Hunter, Andrew
Porter, David (Waveney)


Irvine, Michael
Portillo, Michael


Irving, Sir Charles
Price, Sir David


Jack, Michael
Raison, Rt Hon Timothy


Jackson, Robert
Rathbone, Tim


Janman, Tim
Redwood, John


Jessel, Toby
Renton, Rt Hon Tim


Johnson Smith, Sir Geoffrey
Rhodes James, Robert


Jones, Robert B (Herts W)
Riddick, Graham


Jopling, Rt Hon Michael
Ridley, Rt Hon Nicholas


Kellett-Bowman, Dame Elaine
Ridsdale, Sir Julian


Key, Robert
Rifkind, Rt Hon Malcolm


King, Roger (B'ham N'thfield)
Roberts, Wyn (Conwy)


Kirkhope, Timothy
Roe, Mrs Marion






Rost, Peter
Taylor, Ian (Esher)


Rowe, Andrew
Taylor, John M (Solihull)


Rumbold, Mrs Angela
Taylor, Teddy (S'end E)


Ryder, Richard
Temple-Morris, Peter


Sackville, Hon Tom
Thompson, D. (Calder Valley)


Sainsbury, Hon Tim
Thompson, Patrick (Norwich N)


Scott, Rt Hon Nicholas
Thornton, Malcolm


Shaw, David (Dover)
Thurnham, Peter


Shaw, Sir Giles (Pudsey)
Townsend, Cyril D. (B'heath)


Shaw, Sir Michael (Scarb')
Tracey, Richard


Shelton, Sir William
Trippier, David


Shephard, Mrs G. (Norfolk SW)
Trotter, Neville


Shepherd, Colin (Hereford)
Twinn, Dr Ian


Shepherd, Richard (Aldridge)
Vaughan, Sir Gerard


Shersby, Michael
Viggers, Peter


Sims, Roger
Waddington, Rt Hon David


Skeet, Sir Trevor
Wakeham, Rt Hon John


Smith, Sir Dudley (Warwick)
Walden, George


Smith, Tim (Beaconsfield)
Walker, Bill (T'side North)


Speed, Keith
Ward, John


Speller, Tony
Wardle, Charles (Bexhill)


Spicer, Sir Jim (Dorset W)
Wells, Bowen


Spicer, Michael (S Worcs)
Wheeler, Sir John


Squire, Robin
Whitney, Ray


Stanbrook, Ivor
Widdecombe, Ann


Stanley, Rt Hon Sir John
Wiggin, Jerry


Steen, Anthony
Wilshire, David


Stern, Michael
Winterton, Mrs Ann


Stevens, Lewis
Wolfson, Mark


Stewart, Allan (Eastwood)
Woodcock, Dr. Mike


Stewart, Andy (Sherwood)
Yeo, Tim


Stewart, Rt Hon Ian (Herts N)
Young, Sir George (Acton)


Stokes, Sir John



Stradling Thomas, Sir John
Tellers for the Noes:


Sumberg, David
Mr. David Lightbown, and


Summerson, Hugo
Mr. Timothy Wood.


Tapsell, Sir Peter

Question accordingly negatived.

Lords amendments Nos. 2 to 5 agreed to.

Clause 6

TRANSFER OF STAFF TO NHS TRUSTS

Lords amendment: No. 6, in page 7, line 18, at beginning insert
Subject to subsection (4A) below

The Minister for Health (Mrs. Virginia Bottomley): I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Deputy Speaker (Mr. Harold Walker): With this it will be convenient to take Lords amendments Nos. 7, 45, 46, 91, 136, 137, 139, 140, 150 and 170.

Mrs. Bottomley: The amendments deal with the transfer of staff, both to NHS trusts and from health to local authorities as a consequence of the community care changes in the Bill. The changes relating to the transfer to NHS trusts simply complete the provisions already in clauses 6 and 30. The transfer of staff from health to local authorities, by contrast, is set out in a new clause and in a series of equivalent Scottish amendments. Nevertheless, the same principle unites the amendments—that staff who transfer from one body to another should not lose out in the process. All the amendments provide various protective measures for staff who change employer in those special circumstances. I am sure that the statutory safeguards that they provide will be welcomed by those staff.
Amendments Nos. 6 and 7 and their Scottish equivalents provide statutory protection for staff who

transfer from health authority to NHS trust employment before a trust's operational date. In particular, they specify that, for such staff, employment with an NHS trust shall be counted as continuous with health authority employment. Such staff will be few—mainly a small group of key staff, such as the new trust chief executive, who need to prepare the trust for carrying out is full range of functions.
The issue addressed by the new clause and the equivalent Scottish amendments was raised by Sir Roy Griffiths in his Report on community care and discussed at some length by the Committee, particularly the hon. Member for Monklands, West (Mr. Clarke). That is the need to ensure that the services of experienced staff employed in long-stay hospitals are not lost when responsibility for their patients passes to another authority. Apart from knowledge of individual patients, such staff have a wide range of skills which are equally valuable in a community setting.
The new clause allows regulations to be made to provide for such staffs' service with the NHS and with local authorities to be counted as continuous. That means that their NHS service will be counted for the purposes of any future redundancy payments or action for unfair dismissal. We have opted for a regulation-making power rather than direct power here, because this is a matter which affects a range of interests—health and local authorities and representatives of NHS staff—with whom we shall discuss the regulations.

Question put and agreed to.

Lords amendment No. 7 agreed to.

Clause 8

TRANSFER OF PROPERTY, RIGHTS AND LIABILITIES TO NHS TRUST

Lords amendment: No. 8, in page 9, line 6, leave out from "section" to end of line 7.

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell): I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Deputy Speaker: With this it will be convenient to take Lords amendments Nos. 9 to 13, 20, 47 to 52, 69, 123 to 128 and 146 to 149.

Mr. Dorrell: This group of amendments completes the provisions relating to the financial and other working arrangements for NHS trusts in England and Wales and in Scotland. The amendments build on the financial structure for NHS trusts which was endorsed in Committee and on Report.
The amendments raise four issues. Amendments Nos. 123 to 125 and their Scottish equivalents deal with the funding of NHS trusts before their operational date. They give the Secretary of State power to require health authorities to meet expenses of trusts incurred during this period, in other words before income starts to flow in from NHS contracts. Such expenses are not expected to be substantial, but they will cover key issues such as the pay of a few senior staff who transfer to the NHS trust at an early stage.
Amendments Nos. 10 to 13 and their Scottish equivalents alter the definition of NHS trusts' originating capital debt. They allow all relevant assets to be included in the calculation of the debt. They also allow the Secretary


of State to leave out certain assets and liabilities from the calculation of the originating capital debt. This will enable the Secretary of State to exclude donated assets, for example, from the calculation. These amendments will ensure that the originating capital debt of NHS trusts reflects the true value of their net assets. They mean that the interest payments on the debt will correspond accurately to the capital charges to be paid by directly managed units, putting all provider units in the NHS on an equal financial footing.
The new clauses introduced by amendments Nos. 20 and 69 allow the Secretary of State to establish schemes for meeting costs of claims for clinical negligence and other liabilities incurred by health authorities, NHS trusts and, in Scotland, health boards and the common services agency. At present, health authorities bear their own risks and do not insure. However, many regions hold back funds for districts to meet the costs of particularly large clinical negligence claims. In Scotland and Wales, pooling arrangements to share the cost of high-value liabilities are operated by the Secretary of State. The Bill as it stands will not allow NHS trusts to participate in any pooling arrangements or other risk-sharing schemes. Trusts would have to meet their own liabilities without the option of spreading the risk. I do not believe that trusts, which will remain fully part of the NHS, should have to meet liabilities on a different basis from health authorities. These clauses will enable NHS trusts to participate alongside other health service bodies in risk-sharing schemes established by the Secretary of State.
Amendment No. 128 gives National Health Service trusts powers to purchase land compulsorily in certain circumstances subject to the Secretary of State's prior consent. Again, this amendment is designed to put National Health Service trusts in an analogous position to health authorities, for which the Secretary of State is able to purchase land under the procedure set out in the Acquisition of Land Act 1981. Compulsory purchase orders made under this new power will be subject to the Secretary of State's confirmation. As an additional safeguard, the amendment specifies that no such order may be made without the Secretary of State's prior consent to the proposed acquisition. These provisions will, I am sure, guarantee that this power is used only exceptionally and when it is in the wider interests of the National Health Service.
The other amendments in this group are all minor, technical amendments, and I do not propose to detain the House by describing them. I commend the amendments that I have described, and the minor ones, to the House.

Question put and agreed to. [Special Entry.]

Lords amendments Nos. 9 to 13 agreed to.

Clause 18

INDICATIVE BUDGETS FOR DOCTORS' PRACTICES

Lords amendment: No. 14, in page 18, line 39, leave out
by way of a budget

Mr. Kenneth Clarke: I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Deputy Speaker: With this, it will be convenient to discuss Lords amendments Nos. 15 to 19 and 53 to 57.

Mr. Clarke: This group of amendments changes the terminology in the Bill. What were previously described as indicative prescribing budgets will be called, if the amendments are agreed to, indicative prescribing amounts. This remains the same GP prescribing scheme as we have debated frequently before, but I hope to persuade the House that the change in nomemclature is desirable—as their Lordships were persuaded that it was.
There are two reasons for the change. First, it puts behind us the extraordinary campaigning and the fears aroused by the arguments about indicative prescribing budgets last summer. Hon. Members will recall that, when we first produced our reforms, various interests outside took the view that if the patients could be terrified enough about the prospect of change it would be possible to stop any reforms of the way in which the NHS is run.
Those interests invented a scurrilous claim that indicative prescribing budgets would lead to patients being deprived of medicines that they might require because their doctors would run out of money to prescribe their drugs. I regret to say that huge sums of money were put into the campaign and a great deal of effort was expended on frightening a lot of elderly and vulnerable patients into believing that they might not get the treatment they required. Eventually, I am glad to say, the BMA was persuaded to withdraw the claim and to agree that there was nothing in the Government's scheme that gave rise to any risk of any doctor ever having to refuse a patient medicine.
Unfortunately, the Labour party took longer to come round, because its members had leapt on to this nasty bandwagon and hence took some time to get off it. We all accept now that nothing in the proposals before us in any way imperils patients always being able to receive the medicines regarded as necessary by their doctors. In any case, all our previous debates and the campaigning about indicative prescribing budgets may be put behind us by going over to the word "amounts".
There is another, practical, problem. Much of the debate about my health service reforms keeps turning on budgets of various sorts. I accept that there is sometimes genuine confusion in the arguments of supporters, and frequently in the arguments of critics, about the sort of budgets that will be given to GPs who choose to become fund holders—what we call GP practice budgets—and about indicative prescribing budgets, which are budgets given to all GPs as an indication of what their prescribing costs would be expected to be if they incurred the ordinary and desirable level of costs for the patient mix on their lists.
It will be helpful for the prescribing scheme if we change to the term "indicative prescribing amount", leaving the word "budget" to describe the sums of money that will be negotiated with GPs who choose to become fund-holding GPs because they believe that, by controlling that amount of money, they will be able to influence the development of local services in a way that best suits their practices.
There is no change of policy—merely a desirable change of nomenclature. The Government firmly believe that it is necessary to eliminate wasteful expenditure on drugs in cases in which unnecessary amounts or too expensive drugs are prescribed. It is also sometimes necessary to eliminate dangerous over-prescribing in cases of large quantities of, say, tranquillisers being poured


down the throats of patients for long periods on repeat prescriptions without the patient having to see the doctor who was originally responsible for the prescription.
All hon. Members agree that we should cut out wasteful and dangerous prescribing. Everyone pays lip service to the idea that we should keep down the drugs bill to what it is necessary to spend—no more and no less. I hope that we shall have no more scurrilous attacks on the Government of the sort that we heard last year, and that people will campaign in line with what they say and want. The new scheme will take us nearer to the health service spending only as much as is necessary on drugs. If we can get the scheme running and if the amendments are agreed to, I believe that the phrase "indicative prescribing amounts" will make the scheme better understood.

Mr. Michael: These amendments appear to be a concession; the Government seem to be agreeing to delete all reference to GP drug budgets. But I warn the House that all is not what it seems. I also challenge the Minister to respond to this brief debate with a commitment that the Govenment have refused to write into the Bill.
The only fictitious and scurrilous aspect has been the Secretary of State's appalling series of attacks not only on the Opposition but on every professional group in the NHS, during the debate on this and on virtually every other aspect of the Bill.
In his opening remarks, the Secretary of State gave away the true position—in his words, there is no change of policy. In his words, this remains the same GP prescribing scheme. The Opposition have acted responsibly in warning the professionals and the public what to expect if the Secretary of State is allowed to get away with his changes to the national health service.
We have to deal not only with what is in the Bill but with what is not. The removal of waste and the elimination of over-prescribing or under-prescribing are fine aims, and in due course the Opposition will seek to tackle those matters. The trouble with the GP prescribing scheme, as the Secretary of State described it, is that the Bill does not assert the primacy of patient care in deciding what medication should be given to a patient. The Secretary of State failed to write that into the Bill. That point has been made to me most strongly by doctors.
8.30 pm
Another point made to me is that the Lords amendments make only cosmetic changes to the legislation. It looks like an improvement to have the word "budget" replaced by the word "amount" in clause 18, but is it really? Is there any real change in the meaning? The Secretary of State says that there is not. Will the law when it is enacted be different as a result of this change? Again the Secretary of State says no. This is the result of a game of word search on a word processor to find a different way to say the same thing.
In recent working papers, we have seen a softening of the rhetoric, just as we saw a softening in the Secretary of State's style in this debate. While the legislation does not explicitly threaten the cash limit, there is no guarantee that a Secretary of State for Health or a Secretary of State for Wales or for Scotland will not impose explicit cash limits in future.
Amendments offered to the Minister in Committee were rejected. That rejection clearly demonstrated the Government's refusal to give the precise and simple

reassurance in law that the Opposition, doctors and patients want, need and deserve. I remind the Secretary of State of the two amendments that he rejected. The first said:
there will be no sanction, financial or otherwise, applied against a practice which exceeds its indicative drug budget.
"Drug amount" is the term that the Secretary of State prefers. The second amendment stated:
nothing in this section shall interfere with a medical practitioner's decision to supply pharmaceutical services according to his clinical judgment.
We sought such protection in law, but it has not been given. Those amendments were important, because they sought to protect the doctor's right to prescribe in the patient's best interest. The traditional confidence of the patient in the doctor is the basis of our national health service. It is incredible that the Government are prepared to put that at risk. Public and patient confidence is important.
We drew the Secretary of State's attention to the 1989 poll showing that nearly 25 per cent. of the sample believe that the plan to give doctors a drug budget—or drug amount—would lead to doctors failing to prescribe expensive drugs even when they were necessary. Half the poll sample thought that the drug budget would make doctors more careful, but in what way would they be more careful? They would be more careful not in terms of care in prescribing but in the way in which they controlled the finances. In this matter, as in so many others, the Secretary of State has claimed that we were crying wolf and raising unreal fears.
Since our debates in Committee, we have seen the truth. We have also come to understand why the Government are willing to accept the Lords amendments. They do not need drug budgets in the Bill to undermine patient care, because that is happening already. The damage has already been done to our beloved NHS. The accountants and the computers are already taking over. The examples are manifold, but I will give just a couple. A Cardiff woman went to her doctor for a repeat prescription for an inhaler for asthma. She was told that she could not have that one any more because it cost £17 and the GP could not afford to prescribe it under her budget. The patient was told that she would have to have a cheaper inhaler. A Welsh GP tells of the family practitioner committee producing its estimated budgets for this year and being given only half the budget needs, based on experience.
We hear of more and more people having to have a full medical examination before a doctor will accept them on his list. I do not entirely blame the GPs for that, because a doctor has to consider existing patients. The Government and the Secretary of State are to blame for placing GPs in a dilemma by introducing distortions in the operation of the National Health Service which are wrong in principle and wrong in practice.
The Bill gives great powers to the Secretary of State. He could promise that this shell Bill and the proposed reforms will not stop patients getting the medication that they need, but sadly, that would be an empty promise. The threat to patient care will not be removed by the amendments. The damage is being done and the Bill still fails to offer the positive protection of patient care, which will have to await the general election and a Labour Government.

Mr. Kennedy: I do not want to go into matters as deeply as the hon. Member for Cardiff, South and Penarth (Mr.


Michael). In an emollient way, the Secretary of State described why he was replacing the word "budget" with the word "amount". Presumably a civil servant or the Minister or a policy adviser thought of this change. Was it thought up by the same person who tried to get everybody to use the term "community charge" rather than the term "poll tax"? If so, may we have that person's name?

Mr. Kenneth Hind: I support the amendment. It is sensible because it strikes at one of the main propaganda weapons of the Opposition. They and many of their supporters have many times deployed that weapon against the Bill and it has caused great upset and distress to elderly patients and the chronically sick.
Conservative Members are constantly faced in their surgeries with people who say that, if the Bill goes through, the doctor will not be able to prescribe drugs or give the necessary treatment. That has caused great anxiety, and, despite the Government's reassurances, the Opposition have peddled that argument time and again in an attempt to creat anxiety for political purposes. The beauty of this change of name to deal with the drug budget is that it finally buries what I can only describe as that calumny. Eventually the Opposition will come round to recognising that we are not out of our minds and will not deny sick people the drugs that are necessary to cure them. The constant repetition of that calumny has raised totally unjustified anxieties.
I welcome, as I think do all hon. Members, the desire to deal with waste and the need to encourage under-prescribers to prescribe drugs for their patients. No one will interfere with a doctor's right to prescribe what he thinks is necessary for a patient. That must underpin any decision that is made by a doctor and it underpins the Bill. Making it clear that this is not a budget but an amount underlines that and gives much needed reassurance to the patient.

Mr. Kenneth Clarke: The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) asked who thought up the change of nomenclature. I assume that it was thought up by Lord Butterfield, the Cambridge professor of physic, who moved in another place the amendment that was accepted by the Government. I shall spare the hon. Gentleman most of my strictures, because I think that the campaign waged by the Labour party has been much worse than his. He showed an unfortunate and unintended lapse of taste when he suggested that the Cambridge professor of physic, a distinguished member of another place, was engaged in some sort of public relations exercise.
The amendment makes a sensible change. I presume that the hon. Member for Ross, Cromarty and Skye, like my hon. Friend the Member for Lancashire, West (Mr. Hind) and me, wants to turn the page on some of the campaigning that we have seen on the subject. That caused much harm and frightened many elderly and vulnerable patients.
The hon. Member for Cardiff, South and Penarth (Mr. Michael) continues to move round the subject. There is not and never has been any question of a doctor being put in a position where he could not prescribe the necessary medicine for his patients. It is total nonsense to suggest that that was ever in question. There is no question of any

sanction being applied to a general practitioner who prescribes a necessary medicine. The only scrutiny to which a doctor will be subjected by other doctors is an inquiry into the possibility of wasteful, dangerous or out-of-date prescribing. The prescribing doctor will be expected to correct such prescribing if it is found. The introduction of the change is already having some beneficial effects.

Mr. Michael: Will the Secretary of State give way?

Mr. Clarke: I shall give way in a moment.
The only good thing about the campaign last summer was that it drew more attention than ever before to prescribing costs. The hon. Gentleman said that the labour party had always been against wasteful prescribing. In all the time that I have been connected with health, the Labour party's voting and actions have never supported that bland assertion. The Labour party has resisted our every attempt to reduce the level of waste in prescribing. As a result of that attention and the new data and information available to doctors, there is already evidence that in preparation for the change doctors are examining their prescribing practices. Those who are wasteful in comparison with their colleagues are taking action. The growth in the cost of drugs to the health service is markedly slower this year than in past years and we have not yet introduced the change. Doctors who know that they will be exposed as over-prescribers are taking action to ensure that the "prescribing amounts" do not catch them out next year.

Mr. Michael: The Secretary of State confirms my point on the extent to which administrative action and fear are already having an effect. I invite him to confirm one point. He said that the only judgments made will be by doctors. In Committee we asked for that assurance and it was never given. We were told that the family practitioner committee or a successor body would make the judgment, and that it would be an administrative decision, although taken with the advice of doctors. Tonight he said that doctors would make the judgment. It will be only peer review, if the Secretary of State's sentence is taken at face value. I invite him to say whether he meant it entirely in that way, because I should not like to misrepresent what he said.

Mr. Clarke: I reached an agreement with the profession some weeks ago that the relevant committee of the family practitioner committee would be composed of other doctors. We have reached an agreement on the composition of these committees. With great respect, the hon. Gentleman is amazingly mealy-mouthed in his retreat from last summer's ruthless and unscrupulous campaign. At one point, he said how important it was that every patient had full confidence in the ability of his or her doctor to give all the treatments required. I have never been persuaded by statements made by spokesmen from either the Labour party or the British medical Association that it is important that patients have confidence in their doctors. A great deal of money and effort was put into destroying that confidence last year. A great deal more money was spent on opinion polls to see how effectively patients had been frightened. That was then claimed as a judgment on the reforms of the NHS.

Mr. Tom Clarke: Will the Secretary of State give way?

Mr. Clarke: I shall give way in a minute.
The hon. Member for Cardiff, South and Penarth raised two entirely fresh calumnies which he clearly intends to pursue. He quoted the case of a Cardiff doctor who had told a patient that she could not prescribe a particular appliance because she could not afford it under her budget. The hon. Gentleman knows that that example cannot be genuine because budgets have not been introduced. If the hon. Gentleman had such a case, instead of encouraging and airing it, he should have told his patient that it could not be true. I do not know whether any doctor said that she could not prescribe something because it was not within her budget. But as there are no budgets in place, the hon. Gentleman knows that it must be untrue.
The Daily Mirror follows a practice similar to that of Labour Members. It publishes the most fictitious rubbish in the paper. As evidence in support of its allegations it produces letters from patients saying, "I do not care what my doctor said, I believe that he could not afford to do what he said he could do." That is regarded as evidence to support the Daily Mirror's claims that doctors cannot afford to prescribe certain drugs.
The hon. Member for Cardiff, South and Penarth also suggested that doctors turn patients off their lists because they cannot afford them. The hon. Member for Peckham is also fond of all this. We have explored all the allegations to which the Daily Mirror gives terrific support. So far not one has turned out to be truthful or accurate. The accounts given by the hon. Member for Peckham on the Floor of the House usually turn out to be a ridiculous description of the case about which she is campaigning. I do not believe that anyone has yet found a patient anywhere in the country who was turned off a doctor's list because of the introduction of the NHS reforms. But Labour Members keep saying that they have.
8.45 pm
The hon. Member for Cardiff, South and Penarth made a particularly witty contribution. He said that his patients were discovering that when they went to a new doctor they were given a full medical examination so that the doctor could decide whether they were old and frail and if so throw them off. The hon. Gentleman knows perfectly well that one feature of the new GP contract, which his party bitterly fought, is that GPs are required to offer a full medical examination to new patients. It is a popular innovation with patients. It is an improvement of our family doctor service.
Patients are given a full medical examination to enable the GP to obtain information about his new patient and be appraised of his or her possible health needs. What does the hon. Member for Cardiff, South and Penarth do? Cynicism knows no bounds in opposing the NHS reforms. He tells his constituents that the improvement in the service implies that they are given an MOT test to find out whether they are too expensive. That is how the Labour party won the Vale of Glamorgan by-election. That is how they propose to fight the consultation process over the summer.
Eventually, the more responsible Members of the Labour party will feel ashamed of themselves for aligning themselves with all the more reactionary and backward-looking elements in the NHS. By doing so, they have covered up their lack of policy. Even when mild

amendments are proposed by Lord Butterfield in another place, they take the opportunity to arouse public fears which they know are unreal for unscrupulous objectives.

Mr. Nicholas Winterton: rose—

Mr. Hind: rose—

Mr. Tom Clarke: rose—

Mr. Deputy Speaker: Order. Is the Secretary of State giving way?

Mr. Clarke: I give way to the hon. Member for Monklands, West (Mr. Clarke).

Mr. Tom Clarke: I am grateful to the Secretary of State, even though I have almost forgotten the point on which I wished to intervene. The Secretary of State has left me, if not other hon. Members, with a distinct dilemma. I hope that he will not worry if I tell him that some people detect in him a degree of over-sensitivity and almost paranoia. All afternoon he has said that the Government have involved themselves in an exercise of consultation. Yet when we identified the points on which various individuals, distinguished professional bodies and even the Labour party disagreed with the Government, it became a campaign and it became disreputable. What is the difference between consultation and a campaign?

Mr. Kenneth Clarke: With great respect, I said that we have always promised public consultation on self-governing trusts. We promised it throughout Second Reading, throughout the five and a half hours of debate about it on the previous occasion when the Bill was debated in the House and I have repeated the promise during three hours of debate tonight. Without anyone contesting it, I have introduced the statutory provisions to enable it to take place. I look forward to serious consultation.
As the Opposition chose to discuss these drafting amendments by going back to yet more complaints about prescribing, I chose to give my view yet again of their campaigning on a sensitive subject such as NHS care.

Mr. Tom Clarke: The Secretary of State is paranoid.

Mr. Kenneth Clarke: I am not paranoid. The British Medical Association campaign collapsed in ruins last autumn and the Labour party's campaign ground to a halt shortly thereafter. Now it is trying to get going again.

Mr. Nicholas Winterton: rose—

Mr. Hind: rose—

Mr. Clarke: All that I am anxious to do is to persuade Labour Members from now on in their undoubtedly equally ineffective debating, they avoid methods of campaigning which frighten innocent members of the public.

Mr. Winterton: While I accept the assurances of my right hon. and learned Friend, before he finishes his speech on this amendment, will he pay tribute to the pharmaceutical industry of the United Kingdom, which has played a major role in the balance of payments, provided employment and has always been responsible? It has made a major contribution to improving the health of people in the United Kingdom. Furthermore, does he agree that a majority of doctors has always prescribed


responsibly? If my right hon. and learned Friend's assurances are to carry weight, he must ensure that the good work of the pharmaceutical industry and doctors can continue.

Mr. Clarke: I hesitated to give way to my hon. Friend because he is a persistent critic of mine and he has only just come in to the Chamber. I was trying to shorten the debate. However, I gladly agree with all the points that he made. The pharmaceutical industry took no part in last summer's campaign. All the people I know in the pharmaceutical industry are in favour or responsible prescribing. No one in the industry makes a case for wasteful and unnecessary prescribing.
That is true of the vast majority of doctors. Last year many of them used leaflets that told a lot of lies about the scheme and frightened many of their patients. A majority of doctors put excessive faith in the accuracy of the literature that they are provided with by the BMA. The leaflets and the allegations have completely disappeared. This minor drafting amendment puts that chapter behind us. Responsible doctors and other responsible people connected with the industry are in favour of spending as much on drugs as is necessary—no more and no less. We are introducing a scheme that will enable us to implement that desire. The Labour party always pays lip service to that, but in its actions and campaigns it does everything possible to undermine every attempt to get NHS prescribing costs under control.

Question put and agreed to.

Lords amendments Nos. 15 to 20 agreed to, one with Special Entry.

Clause 22

DISTRIBUTION OF GENERAL MEDICAL SERVICES

Lord's amendment: No. 21, in page 23, line 10, after "specify" insert "(a)".

Mr. Dorrell: I beg to move, That this House doth agree with the Lords in the said amendment.

Mr. Deputy Speaker: With this, it will be convenient to consider Lords amendments 22 to 34 and 59 to 68.

Mr. Dorrell: The amendments primarily reflect the outcome of discussions with the medical practices committees about the practical implications of our proposals on GP manpower, job-related GP appeals and part-time working by GPs. They therefore address the management issues relating to general practice.
The first group of amendments deals with GP manpower. We made it clear in the White Paper that we intended to take two additional powers to improve our ability to manage the number of GPs practising within the GP service. The relevant paragraph of the White Paper, paragraph 722, commits the Government unreservedly to ensuring that there is adequate access to family doctors across the country. It also says that it is a legitimate concern of the Government to ensure that there is a proper balance in the number of doctors as between the hospital service and general practice.
In order to give practical effect to those policy aspirations, the Government announced that they intended to take two further steps to enable it better to

control the total cost of the NHS. We announced that we intended to seek reserve powers to control, if necessary, the number of GPs entering into contracts with the NHS. We also said that we would seek in due course to reduce from 70 to 65 the retirement age for GPs.
The amendments address the first issue, the total ceiling on GP manpower. We now accept that we should define the reserve powers to control GP numbers as applying nationally, not area by area. There was some concern that the powers could not be made to work effectively and deliver the results that we wanted if we sought to exercise the power to control total GP numbers at any level below the national level. The amendments provide us with the power to impose that total limit on GP numbers at national level. Separate limits may apply in England and Wales. Clause 38 provides that separate limits can apply in Scotland.
The second of the management issues that is addressed by this group of amendments deals with appeals. We had intended that the two medical practices committees should consider appeals on points of law by GPs against decisions by the family health service authorities in England and the health boards in Scotland. However, the committee doubted whether it would be practical for it to deal satisfactorily with appeals from GPs on points of law. Therefore, we have accepted the argument that the appeals process should continue to be directed to the Secretary of State rather than to individual family health service authorities.
This group of amendments also clarifies the provisions relating to part-time working and job sharing by GPs. It builds on the major innovation that was announced in the White Paper and introduced into the Bill on Report in this House. We have made it clear that all GPs will need to be admitted to the medical list on either a part-time or full-time basis. GPs can appeal to the Secretary of State against decisions by the medical practices committees to refuse to vary the conditions on which they were admitted to the medical list. GPs already working part-time under locally agreed arrangements will be transferred automatically to the new scheme. Their position will therefore be fully safeguarded.
The amendments improve the provisions in the Bill for the management of general practice, to the benefit of both GPs and their patients. I commend them to the House.

Question put and agreed to.

Lords amendments Nos. 22 to 69 agreed to, some with Special Entry.

Lords amendment: No. 70, before clause 40, insert the following new clause—
 .—(1) The Secretary of State shall, with the approval of the Treasury, make grants out of money provided by Parliament towards the expenses of local authorities incurred in connection with the exercise of their community care functions.
(2) Grants made in accordance with subsection (1) above shall be used by local authorities solely for the provision of community care for purposes described in plans drawn up in accordance with section 44 below.
(3) The Secretary of State shall not later than 30th November in the year preceding any financial year lay before Parliament his estimate of the total amount of grant likely to be disbursed under this section in respect of that financial year, together with a statement of the sums requested by local authorities and the formula for distribution between such authorities, and shall at that time publish forecasts for the following two financial years.

Amendment proposed: (a), after subsection (2), at end insert—


(2A) The Secretary of State shall by regulation make a scheme whereby local authorities may make payments to disabled persons or other persons in receipt of community care services for the purchase of care or personal assistance services, subject to subsection (2B) below.
(2B) For the purpose of the scheme made under subsection (2A) above, section 29(6) of the National Assistance Act 1948 shall not apply.
(2C) The Secretary of State shall issue guidance to local authorities in association with the scheme made under subsection (2A) above, for the purpose of assisting them in ensuring that any payment made by them under the scheme are subject to arrangements sufficient to ensure that the authorities have satisfied their fiduciary duties..—[Mr. Rowe.]

Mr. Deputy Speaker: With this it will be convenient to take the Government motion to disagree with the Lords in the said amendment, and Government amendments (b) and (c) in lieu of the Lords amendment.

9 pm

Mr. Kenneth Clarke: I should explain to the House that, although the amendment is unacceptable, the Government, recognising the widespread concern about the subject, have tabled an amendment to clause 47 that would enable me and future Secretaries of State to make grants to voluntary organisations to assist them with the expense of providing services to people who are over-dependent on drugs and alcohol.
Lords amendment No. 70 touches on ring fencing and the arguments that we have had during the passage of the Bill about whether grants made by central Government towards the costs of the new care-in-the-community responsibilities that will be placed on local authorities should somehow be ring fenced.
Before we plunge into the intricacies of local government finance, which I shall try to avoid but which are almost unavoidable, we should at least touch base. We are talking about a policy which is certainly the most popular that I ever put forward and which has received widespread support—the policy of making clearer the responsibilities for care given in the community to elderly, disabled, mentally ill and mentally handicapped people. The policy was based on the second Griffiths' report on this subject.
In future, local authorities will have new resources and responsibilities to make an individual assessment in the case of each citizen who may need support to live in a non-institutional, non-NHS setting, and to reach a judgment about how best to provide services, within the resources available, and to support those people, and the families and friends who help to care for them, in achieving the best possible quality of life in or near their own homes.
We have had many arguments about the subject. At one point, I was accused of going too slowly in my response to the Griffiths report. Then I was accused of going too quickly—of rushing to include proposals in the Bill after a short period of consultation. But at no stage has anyone seriously challenged the desirability of that policy, and we are now talking about its implementation. The Government have always made it clear that, when the new policy is introduced, adequate resources should be available to enable the local authorities to put the framework in place and to begin the process of steadily raising the quality of care in the community to the level which I am sure people will expect such services to reach by the end of the decade.
The obvious source of finance is the transfer, by agreement, of money from the budget of my right hon. Friend the Secretary of State for Social Security—away from the present arrangements which give open-ended access to income support to those who go into residential care homes—across to local government, as an added contribution to central Government grant, to enable it to finance the individual assessment of its provision of care in residential care homes or by way of domiciliary provision. We have always said that we shall not only transfer what the Department of Social Security is spending at the time of the transfer but will anticipate the growth in the social security budget and make reasonable assumptions about the direction in which demography and the desire to expand services are likely to take local authorities.
There is no doubt that the Government have embarked on a policy that is popular and widely accepted in the field. We have also undertaken that, when the policy is introduced, extra resources will be transferred to the local authorities in the manner that I have described.
The result is that, although Lords amendment No. 70 is very important—I have no doubt that there will be controversy about it in the House—we are arguing not about the wood but about one of the trees. In my opinion, exactly what we mean by ring fencing and by this particular intricacy of local government finance remains somewhat obscure to those who think that they have views on the subject. In the minds of some, ring fencing has acquired a symbolic quality. They have heard that rather nice people are in favour of ring fencing and have concluded that, if the Government oppose ring fencing, there must be some doubt about the Government's commitment to our own policy or about our commitment that the local authorities will have the resources to implement that policy.

Mr. Ieuan Wyn Jones: Does the Secretary of State agree with Sir Roy Griffiths's definition of ring fencing in the White Paper?

Mr. Clarke: I agree with the definition, but I do not agree with Sir Roy Griffiths's proposal—and nor do the amendments exactly reflect those proposals. In his report to the Government, Sir Roy advocated specific grant as a mechanism for transferring funds. I must admit that I do not have his report instantly to hand, but I have obviously discussed it frequently with him. He regarded specific grant as a mechanism whereby central Government could control local government expenditure on the subject, and central Government could exercise influence over the provision of care by local authorities.
I cannot speak for Sir Roy, but I think that he adheres to many of his proposals. I work closely with him, because he is deputy chairman of the NHS policy board, and, indeed, was at a board meeting with me this afternoon. His suggestion was that each care plan produced by local government should come to central Government, and that money be released through specific grant when the Government are satisfied with the plans provided.
We did not go along with that proposal—I do not believe that it is practicable. It would involve me and my Department taking on a great obligation and having people to vet community care plans before distributing money. I do not want officials in my Department second-guessing what local authorities are doing. It is unreal to imagine that we can get that degree of control


over local government. I also do not think that it is much of a sanction to threaten that we shall not release money to Hackney until we are satisfied that Hackney's plans are all right. It would not work like that. For that reason, we have moved away from Sir Roy's proposal.
Various other forms of ring fencing are kicking about. Some people solemnly suggest that we should have a specific grant that specifies the maximum to be spent by local government on the policy, keeping rigid control in the hands of central Government. The Lords amendment envisages a minimum, with local government finding other money from elsewhere, principally the community charge, on top of the ring-fenced sum for the new money to be added. Although I accept that it is not a million miles from Sir Roy Griffiths's proposal, Lords amendment No. 70 does not represent the Griffiths report, any more than the Government's version does.

Mr. Tom Clarke: The Secretary of State says that the amendment does not necessarily reflect precisely Sir Roy's recommendation. Conversely, will the Secretary of State confirm that Sir Roy has publicly supported the Lords amendment?

Mr. Kenneth Clarke: I did not know that he had done that, but I have made it clear—I have had fairly regular contacts with Sir Roy Griffiths—that I think that he is still attracted by the idea of a specific grant. However, he also understands that, after considering the point, the Government decided that it was not appropriate. I tried to give the reasons why, at an early stage, we turned from that part of Sir Roy's otherwise excellent report from which we extracted the main points of policy that we have been following.

Sir David Price: Is my right hon. and learned Friend aware that, in the Select Committee report, we offered him five variations of ring-fencing specific grants, from which he may take his choice?

Mr. Clarke: Perhaps I should return to why I do not like any specific grants of the kind that have been described for all the new responsibilities and care in the community.

Sir Michael McNair-Wilson: Will my right hon. and learned Friend give way?

Mr. Clarke: I shall give way once more and then I must deal with the general case.

Sir Michael McNair-Wilson: Does my right hon. and learned Friend agree that the danger with ring fencing is that it can become restrictive and therefore deny essential flexibility?

Mr. Clarke: I am grateful to my hon. Friend, and I am sure that that is the case. The people in another place who supported amendment on ring fencing—quite a number of my hon. Friends and some Opposition members are urging it now—believe that it would be a useful mechanism to put a lever on the Government to put up the amount of money that we spend. That is good in a good year. However, it would give the Government every opportunity again to identify to other parts of the local government system the restraints that they want to impose on the growth of care in the community in future years. I am not sure that the short-term reasons that attract people to that arrangementat

the moment are likely to be good and lasting for all time. It is a double-edged sword which some directors of social services are asking us to wield in their budgets.
My starting point is what the policy is. We are clearly giving local authorities responsibility for policy, and they should expect to be accountable for it. Responsibility involves a range of activities, such as assessing individual clients, and arranging for care. As in all social policy, that involves a local authority taking on board the choice of priorities, deciding what can be afforded for certain clients and the emphasis that it wants to give, and deciding what priority to give to that part of its policies as against other parts of its social services provision. Those in responsibility cannot make judgments about finance in different parts—

Mr. Nicholas Winterton: Will my right hon. and learned Friend give way?

Mr. Clarke: I shall give way later, because if I am not careful I shall make a long speech.
Those in local government are accountable to their electorate for all local government services. It is artificial to extract accountability for part of its services.
It is a mistake for the House and the Government to believe that somehow we can transfer responsibility to local government but retain the ability to make key judgments about what proportion of the social services budget should be spent on community care. All the history of central Government trying to do that with local government shows that it is unworkable.
The Association of County Councils is against ring fencing. Many people in local government remember when far more local government money came from specific grants on which Parliament and Government insisted. They felt hog-tied in their choice of priorities.
Following that path would sit curiously with the other provision that we give local government. A case for ring fencing could be made for every aspect of local government policy. The Department of Health steered the Children Bill through the House last year. Hon. Members who served on the Standing Committee and those who took part in debates in the other place were enthusiastic about raising the standard of local authority care for children. In the light of what has happened this year, I am convinced that, if they had thought of ring fencing, all those enthusiasts, including Conservative Back Benchers, would have tabled an amendment to ring-fence the money for local authority provision under the Children Act 1989, which will become a new obligation on local authorities in October next year.
Some hon. Members take part in education debates. The House would be full of enthusiasts for ring fencing education grants. In recent years, there has been a growth in specific grants for education, which, by and large, are resented by education authorities, although the small grants tend to be fairly desirable. We cannot return to a system whereby, when the House is dealing with a new subject, we suddenly invent a new separate and specific grant for a part of local authorities's responsibilities.

Mr. Hind: Many Conservative Members are concerned that my right hon. and learned Friend should answer the criticism that was made by the directors of social services in their response to the Griffiths report, in which they bluntly said that they were concerned that certain local


authorities would spend the community care budget on filling holes in the road. That is what started the ring-fencing argument.

Mr. Clarke: I accept what my hon. Friend says. Many of the people who are arguing for ring fencing believe that. I have given the general case against it, which is why we should not go down this route as a response to those fears.
I do not believe that those fears are real. Every director of a local government service would like his budget to be protected while he retains the ability to raid other people's. The person in charge of transport would love to have his budget ring-fenced and to be a predator on other budgets, and the same applies to directors of education and social services. Since we have made block grants to local government, it has been much more free to choose between one service and another. All the experience shows that social services do not lose under block grants. Year in and year out, the expenditure of most local authorities on social services tends to exceed that set down as the norm by Government under the grant-related expenditure assessment or the standard spending assessment and the money comes from other services such as transport, which is a frequent loser. There is nothing to suggest that social services have suffered predation by local authorities for the sake of other calls on their budget.

Mr. Jack Ashley: rose—

Mr. Nicholas Winterton: I am sure that my right hon. and learned Friend is aware that the block grant was introduced by our right hon. Friend the Member for Henley (Mr. Heseltine) and our hon. Friend the Member for Bury St. Edmunds (Sir E. Griffiths) under a previous Conservative Government and that there is considerable support, even on the Government side, for the reintroduction of a specific grant, not least from our hon. Friend the Member for Bury St. Edmunds.
Does my right hon. and learned Friend agree that the Government are handing over to local government considerable responsibility for vulnerable groups? Will he share with the House his concern that if local government were capped even more than in this financial year, as it could well be, those vulnerable groups who cannot represent themselves—the mentally ill, the mentally handicapped, the elderly and the disabled—could be disadvantaged because money allocated in the standard spending assessment by the Government for community care may not all be spent on community care, but may be spent on more desirable, romantic sectors of local government expenditure?

Mr. Clarke: Obviously, my first answer is the one that I have just given. Experience of local government tends to show strongly that social services do not lose out to other services. It tends to be the other way round, because most local authorities of whatever political complexion tend to share my hon. Friend's concern for these groups. Local authorities tend to protect spending on those groups rather than on other parts of the budget, such as holes in the road, which in past periods of local government restraint have obviously not rated highly in the priorities.
I shall return to my hon. Friend's argument having dealt with my final practical point. I am still unclear about how the advocates of ring fencing think that they would

ring-fence an identifiable block of work. Local government already has care in the community responsibilities. All our social services authorities provide home helps, meals on wheels, respite care and many other services to people in the community. A new responsibility is now being added.
There would be appalling problems in trying to define exactly the subject matter of the community care block grant. In particular, one would have to decide where to put the line between this and the rest of the social services budget. There are endless practical cases where a particular client, to use the social worker word, is not in the category labelled "care in the community client" rather than "other social services client". The work is blurred at the edges, so definition would be difficult.
The amendment leaves to the Secretary of State and his Department the other simple task of deciding on a formula to distribute the money, and so on. The amendment has practical problems.
My hon. Friend the Member for Macclesfield (Mr. Winterton) and many other right hon. and hon. Members are worried that without ring fencing we could leave vulnerable groups open to possible losses in their budget which we might otherwise avoid. Obviously, we depend mainly on the policy, which is an improvement. The new funds that will be given will pave the way to an expansion of service. Furthermore, other controls are built into the Bill which will enable us to monitor the provision of care.
All local authorities will be required to produce community care plans. They will be required to consult on them with health authorities and others. Therefore, we shall have more opportunity to feed in news about the quality and nature of local authority provision than now. Part of the new policy includes enhanced powers for the social services inspectorate. Therefore, other areas of what I would call, perhaps unsuitably, quality control are being built into the Bill. Inept use of local government grant powers will not be the effective way to look after the standards of provision.
If hon. Members want to return to the old system of distributing money to local government whereby it was given set sums for each task, they should vote for the amendment. The Association of County Councils is against the amendment, and I believe that most of the other local government associations would not be in favour of returning to the old method of giving out money on a service-by-service provision. I believe that we are right not to want to return to the old system. The block grant is an improvement, particularly for matters which are a local government responsibility. For such matters, local government must decide its priorities.

Dame Jill Knight: My right hon. and learned Friend referred to the Children Act 1989. In the light of the Stephanie Fox case which occurred only a week or so ago, does he believe that the money allocated by the House to protect children under the provisions of that Act was sufficient and was used to protect that child? It was the intention of the House that the money should be used in that way.

Mr. Clarke: I hope that my hon. Friend will forgive me if I do not refer to the Stephanie Fox case in detail. My hon. Friend the Minister for Health answered a parliamentary question about that case recently. I do not believe that resources were the key issue in that case, but


I should prefer to give a more considered response if the matter is raised in a more structured way on another occasion. I will give way to the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) if he still wants me to.

Mr. Ashley: I thought that the Secretary of State was avoiding me. The Secretary of State argues that if we press for ring fencing for community care, we should logically extend it to education, children and other needs. Will the right hon. and learned Gentleman consider the possibility—I believe that it is a certainty—that those receiving community care are not popular in the sense of receiving a popular allocation? They are not politically popular. As the hon. Member for Macclesfield (Mr. Winterton) said, severely disabled people, and especially mentally disabled people, are not popular. That is why money for them should be ring-fenced. We would not press for general ring fencing.

Mr. Clarke: I hope that I can meet the right hon. Gentleman's point. Some of the people about whom we are talking are, to use his phrase, politically popular. The elderly are popular, as are the disabled who are a powerful lobby, in which the right hon. Gentleman takes an active part. I agree that some local authorities are less inclined to give the correct priority to mentally ill people. I also believe that local authorities are inclined to cut grants to voluntary bodies when they are under budgetary pressures. Drug and alcohol abuse are not always popular recipients of social services money.
The case is made for specific grants, in education, social services and elsewhere on a smaller scale than the amendment contemplates. I am in favour of small specific grants, where we give a block of money to local government to induce it to provide a service which, if it were left to itself, it would be inclined not to provide. From the word go, we have always had a proposal for specific grant for community care services and for mentally ill people.
Some local authorities have a bad record of community care provision for mentally ill people. Some hardly bother with it at all. For that reason, we are introducing a new and particular form of specific grant. The money will be handled on our behalf by the district health authorities which will disburse the money to local authorities as they produce plans which fit in with the health authorities' plans for the discharge of patients from hospitals or the care of patients in the community.
In response to the Lords amendment and to the pressure from all sides on ring fencing, with which I have dealt, we have looked again at the position of people who are dependent on drugs and alcohol and at the work of the voluntary bodies that deal with drug and alcohol abuse. Among others, my hon. Friend the Member for Ealing, Acton (Sir G. Young) referred in Committee to the fear felt by the voluntary organisations about the arrangements that we were proposing for the financing of care in the community. That concern was also raised in another place. Voluntary organisations have expanded their work in recent years, largely on the basis of the current availability of income support at the registered home rates. That is one of the things that we are doing away with. Under the new policy, there will be no access to such income support.
We have all encountered people who work with those with drug and alcohol abuse problems who say that they fear the loss of income support money because they are dependent on the local authorities which might not give them the necessary grants. That is why our amendment proposes that the Secretary of State should be able to make specific grants to local authorities for use in helping voluntary organisations with the services that they provide for people who are dependent on drugs or alcohol. Our amendment refers to
persons who are, have been, or are likely to become dependent upon alcohol or drugs".
The provisions would enable local authorities to assist with the preventive work that is undertaken by the voluntary organisations, as well as to assist them with the services that they provide for those who are dependent on drugs or alcohol or who are recovering from such dependency.
I hope that, having heard me answer the general case, the House will accept that we have responded to an important point that has been worried away at ever since the Bill was introduced. People have named the voluntary bodies which could envisage the loss of their income support funding and which were dubious about whether their local social services departments would want to continue giving them a grant for their work with, for example, drug abusers. Indeed, as the right hon. Member for Stoke-on-Trent, South said, some local authorities might be tempted to give a pretty low priority to the work of outside agencies for unattractive groups, such as drug abusers.
Therefore, I say to the House—if I was in another place, I should say it to their Lordships—that I hope that those who have worried at that issue will accept that they have won a significant point. Alongside the commitment that we have already given to make specific grants for the services for mentally ill people, we are now putting on the face of the Bill, in primary legislation, a specific provision for grants to voluntary organisations, which the Government will fund. The Government will be accountable for the sum of money that is allocated for that purpose. To use the jargon, that money will be ring-fenced and local authorities will be able to spend it only on grants to such bodies.

Mr. Hinchliffe: The Secretary of State seems to have undermined his central argument against the Lords amendment by making a concession on that point—although I welcome the fact that he has. Like many people outside the House, I am puzzled by why the right hon. and learned Gentleman has conceded on the issue of specific grants for mental illness, but not for mental handicap. I cannot see any logical difference between the two.

Mr. Clarke: I was always in favour of specific grants for mental illness services. I was a strong advocate from the word go, and such provision was always in the policy. If the hon. Gentleman looks at the current provision made by the local authorities, he will find that only 3 per cent. of the total budget is spent on services for mentally ill people. The proportion varies from authority to authority. In some authorities the provision is minuscule. The provision for services for the mentally ill had therefore been given too low a priority.
There is also the problem of liaison with the health authorities themselves. I believe that most hon. Members support modern mental illness policies and accept that


there should be smaller institutions and care in the community. However, most of us also accept that that works badly in practice. Indeed, my hon. Friend the Member for Macclesfield is alway pressing me about people who slip through the net and he sometimes attacks the policy. However, he is right to say that we know that, however good that policy may be in theory, it does not work well in practice in the country at large. That is why there is a wholly separate case for a specific grant for mental illness provision.
My proposition is based on the view that where it is reasonable to suppose that certain groups might be unpopular, a small amount of the local government allocation can be ring-fenced in specific grants. That is the way in which we shall induce authorities to spend more than they otherwise would on that part of the provision. It is taking that much too far—I do not think that I have undermined the basic case—to say that a huge block of money, being a high proportion of the money available for care in the community activities, should be ring-fenced and specific grant-based in that way. There is no evidence to suggest that social services have come under pressure from other services under the comparative argument for resources. There is no really sensible way of separating the money with clear borders, from the rest of social services provision.
Going for specific grants of that kind would be to go back on every development in local government finance in recent years. Some aspects of the relationship between central Government and local government finance are an improvement on some years ago. To stay with the basic objective of a block grant, leaving local authorities to choose priorities among their overall responsibilities, remains sound.

Mr. Nicholas Bennett: I spent eight years as a local authority member, and served on social services committees for six of them. In the whole of that time, the debate was about more freedom for local authorities to decide their own priorities and how money was to be spent. We welcomed the abolition of specific grants for a whole range of local authority services. It is peculiar to hear people arguing to go the other way and to suggest as do some in local authorities, that they cannot trust themselves? Does not my right hon. and learned Friend find that strange, and does he have more faith in local authority members than do some right hon. and hon. Members?

Mr. Clarke: My hon. Friend makes a persuasive point and is correct in saying that the balance of local government opinion in recent years is that the way things have gone is to be welcomed by all political parties.
I have a letter from Mr. Robin Wendt, secretary of the Association of County Councils, who says:
This is to confirm that the ACC would not support a system of specific government grant towards the general revenue costs of community care, and would endorse the line taken by the Secretary of State in the House of Commons earier this week.
It would be putting the clock back to return to the concept of central Government earmarking funds for particular purposes.

Mr. Nicholas Winterton: What about capping?

Mr. Clarke: I hear arguments about capping, but there is agreement in the House on our policy of care in the community. There is a clear undertaking that when it is introduced, adequate funds will be made available. There is no problem about that. We are immersed in the details of local government finance, and as Secretary of State for Health, I will go as far as I need into local government finance and no further for the purpose of this debate. I am sure that you, Mr. Speaker, would rule me out of order if I embarked on a general debate on local government finance.
Capping is imposed not on councils that are in difficulty providing essential services but on those that have so mismanaged their affairs that they are incapable of delivering a decent service within the amount of expenditure incurred by reasonable councils elsewhere, and without prejudice to cases that may be proceeding before the courts at the present time.
Within the right level of resources, every local authority has the responsibility and duty to distribute its own resources, allocating them to the headings it thinks best. It should be accountable to its own electors for the standard of care that it then produces.

Mr. Rowe: The amendment in my name and that of my hon. Friend the Member for Ealing, Acton (Sir G. Young) is important. The Bill engendered considerable excitement because its intention appeared to be to give power to the consumer to an extent that has hitherto not been forthcoming. We have a long way to go before the consumer becomes sovereign in this difficult field, but there is no doubt that that is the intention of the Bill, and we welcomed it on that basis.
Having been given an assurance in Committee that consumers who had been given a right or an opportunity to manage part of their own budget in a way which enables them to purchase and control the purchase of services, arid who have done that with tremendous skill and to their own great satisfaction as it restored to them a degree of independence, it was a shock to discover Ministers appearing to resile from that assurance. Apparently, local authorities providing mostly severely disabled people with a part of their care budget for them to control might be in danger of being ruled illegal for doing so. The disabled and others who have had the ability to control part of that budget should be able to continue to do so.
I received a letter from the Spinal Injuries Association which is typical of the concern that has been expressed. It states:
Government Ministers have on many occasions given their support to the many schemes already run by local authorities. A number of our members benefit from there schemes and they all work most successfully. The ability to arrange their own personal care assistance gives them independence, choice and control over their lives which would otherwise be unattainable due to the severity of their disability.
That is what community care is about and exactly what we should aim to achieve. I want to secure a categoric assurance from my right hon. and learned Friend that the existing schemes and future schemes that could be made to work will not be put at risk.
The case against such schemes is the difficulty in defining those cases in which such expenditure authority should be given to the consumer. It is said that we could end up with all sorts of people asking for cash in hand. How would we know that they would not spend that on


drink? We have heard that argument and all the others ad nauseum since the 19th century. Such arguments are demeaning to the tiny handful of people for whom the schemes have operated and the limited number for whom they are likely to operate.
People who want to manage their care in such a way will attempt to do so in a meticulous manner. If they are put under normal accounting procedures and are expected to account, monthly or quarterly, for how they spend the money, I cannot believe that there is any danger of the money being wrongly applied. I cannot imagine that people would damage their own care programme by pursuing such procedures badly. I hope that Ministers will give us an assurance about this issue.
I am one of those hon. Members who feel strongly that ring fencing would be a serious mistake. I have experienced a major reorganisation of services—I took part in the reorganisation of social work in Scotland—and I know that, once one reorganises a major service, the professionals begin to defend their frontiers. They put their tanks on the lawn. If ring fencing is provided for one group of professionals, all the others who may still retain a desire to co-operate closely with those professionals will feel less inclined to do so, because they will feel that those professionals have secured their money.

Mr. Favell: Does my hon. Friend agree that the councils involved with social services are more important than the professionals? The directors of social services departments are concerned about having to argue their case with their fellow councillors and directors on local authorities. They believe that the Government would be easier meat. That is what this is all about.

Mr. Rowe: I am not sure whether that is exactly so. My right hon. and learned Friend has already said that the record on social services has shown that in most part of the country social services departments have held their own well against other claimants on local authority budgets.
If community care is to work properly, we have to ensure that the consumers of community care are provided with satisfactory housing and receive education which allows them to live in the community. They have to be sure that they can maintain the in-and-out relationship with the health service that many of them require. If we ring-fence too firmly the budget for community care, we shall put up shutters between professions and make the increasingly promising co-operation between the various services much harder to achieve.

Mr. Robin Cook: I begin by welcoming the Secretary of State's amendment. He will recall that there was some debate on the matter in Committee and that both sides of the Committee supported making particular provision for those who had been involved in drug or alcohol abuse. We are glad that, even at this late stage, the Secretary of State has been able to respond to that anxiety. However, the amendment makes it all the more confusing that the Secretary of State believes that there is an issue of principle in resisting the idea of ring fencing. Whether or not we disagree with the Lords amendment tonight, when the Bill leaves this place it will contain two specific pieces of ring fencing—grants for those who are mentally ill and grants for those involved in drug or alcohol abuse. What is at

issue in this debate is extending the same protection of ring fencing to other client groups of community care such as the elderly, the mentally handicapped and the disabled.
The Secretary of State asked what is different about that part of local authority expenditure which would justify departing from general grants and providing specific ring-fenced grants. I can answer that question. As the Secretary of State explained to the House, the concept behind this part of the Bill is the transfer of resources from the Department of Social Security, which currently supports elderly, mentally handicapped or disabled people who live in residential care, to the local authorities which will have the responsibility for meeting the bills for those client groups.
The House should contemplate ring-fencing those grants as without ring-fencing there is no guarantee that the resources transferred from the DSS to local authorities will be spent on those client groups. Without ring-fencing, the money could be spent on education, highways or industrial development—all splendid, excellent purposes in themselves, but not the functions for which the resources will be transferred. Without ring-fencing, the real danger is that the paradox of the Bill will be that instead of promoting community care we shall diminish the expenditure of the DSS without producing a corresponding increase in local authority spending.
At the beginning of his speech, the Secretary of State said that resistance to the Government's position and support for ring-fencing was partly based on the obscurity of the issue. This is a bipartisan debate, so let me counsel the Secretary of State in a friendly spirit—[Laughter.] Perhaps he should wait until I have finished before he gets too excited. If I may counsel the Secretary of State as a friend, one of his less attractive features is to lecture those who disagree with him on the basis that they do not know what they are talking about. However, the Secretary of State stands absolutely alone among informed opinion on this issue.
Sir Roy Griffiths certainly knew what he was talking about, and he stands by his original proposal for ring-fencing. At the outset of its report, the Select Committee quotes Sir Roy Griffiths:
I have provided a purposeful, effective and economic four-wheeled vehicle, but the White Paper has redesigned it as a three-wheeler, leaving out the fourth wheel of ring-fenced funding.
There is no suggestion that Sir Roy Griffiths regarded ring-fencing as just another tree in the wood—to use the Secretary of State's analogy. Ring fencing was essential to the balance of Sir Roy Griffiths' package.
All the voluntary organisations that are concerned with the client groups want ring fencing. When preparing for this debate I received representations from the Spastics Society, Age Concern, the Royal National Institute for the Deaf, MENCAP, the National Council for Voluntary Organisations, the Carers National Association and RADAR—the Royal Association for Disability and Rehabilitation—which specifically asked me to say:
RADAR will be deeply disappointed if the Government rejects the Lords amendment on ring fencing.

Mr. Michael Jack: Which local authorities have written to the hon. Gentleman about this? Has he personally received a representation from the Association of County Councils on this issue? Will he place on record


which Labour-controlled local authorities would not carry out their responsibilities for community care along the lines that he suggests?

Mr. Cook: I can happily answer the hon. Gentleman's first question about which local authorities have written to me on the issue—88. I have carried out a survey of local authorities.

Mr. Jack: There are 400.

Mr. Cook: There are not 400 social services authorities, if I may correct the hon. Gentleman. I hope that I can do so without falling into the Secretary of State's error of saying that he does not know what he is talking about. There are only 116 social services authorities, and 88 is a good response rate.
In an earlier speech during the debate on the guillotine motion, the Minister for Health unfairly chided the hon. Member for Lancaster (Dame E. Kellett-Bowman) for lacking confidence in local authorities.

Dame Elaine Kellett-Bowman: I have no confidence in Lancashire.

Mr. Cook: I had hoped to assist the hon. Lady and I am terribly sorry if I have succeeded in causing offence. I think that the hon. Lady served on a local authority at one time, but not in Lancaster.
Those of us who listen to what local authorities are saying about ring fencing do not lecture local authorities on what we think is in their good, but show greater confidence in them. I can give the hon. Member for Fylde (Mr. Jack) the precise breakdown he seeks. Of the 88 local authority directors of social services who responded to me, 84—[HON. MEMBERS: "That is different."] The directors of social services certainly know what they are talking about and cannot be accused, as the Secretary of State accused his critics, of being involved in obscuring the issue and failing to understand what is at stake. They are the very people who will have to administer care in the community. I deprecate the way in which some Conservative Members jeered at the mention of the directors.
Of the directors of social services, 84 supported ring fencing and many said that it was essential. Only two local authority directors of social services were against ring fencing. Both of them came from Labour councils, one of which is so popular with the Government that it has just been poll tax-capped.

Dame Elaine Kellett-Bowman: I have no quarrel with the Ministe, because I have no confidence in Lancashire local authority to spend the money on social services. It will blue it on anything it likes. My hon. Friend the Minister obviously has more confidence in the Lancashire authority than I have, but she does not live there; I do.

Mr. Cook: A sound rule that I am sure all hon. Members follow when canvassing is that, when promised a vote, one does not inquire too closely into the motivation for it. I have possibly gone too far against that rule on this occasion.

Mr. Hind: The hon. Gentleman made a good point when he took up my hon. Friends' comment on the social services directors. I take on board what the directors said, but what do the local authorities and the elected representatives think? I appreciate that the hon.

Gentleman has gone to the experts, but what do the people whom they serve think? That is an entirely different matter.

Mr. Cook: The hon. Gentleman is right that there is a distinction here, but it is not as great as he suggests. Many of those directors made it clear that they spoke on behalf of their committee and their local authority. I am not aware of a single director who made representations to me which are in conflict with the position of his local authority and I should be surprised if there was one.

Mr. Hind: What about the Association of County Councils?

Mr. Cook: The ACC is out of step, but all the other official organisations of local authorities are in favour of ring fencing.

Mrs. Audrey Wise: Will my hon. Friend give way?

Mr. Cook: I will give way to my hon. Friend, but this must be the last occasion.

Mrs. Wise: The Select Committee report says that the Association of County Councils stated:
The Association's view is that the major element of Government financial support to local government should be by means of a general grant mechanism. The Association also accepts that there is a role for specific grants in certain circumstances. One such clear role would be to recognise the additional costs of preparing for implementing the proposa Is in the White Paper … Community Care resources must be actually available to individual social services authorities. This implies the separate identification of resources for individual authorities".
Therefore, the ACC is not really out of step. It is asking for specific identification.

Mr. Cook: I am grateful to my hon. Friend for clarifying so clearly the ACC's position, although I did not expect that she would emerge as its spokesman.
The Secretary of State referred to the increase in social services expenditure during the past 10 years. That point was also made by the Minister for Health in the earlier debate. Both quoted a 37 per cent. increase in social services authorities' expenditure.
During the past few years, there has been an increase in social services expenditure. I am bound to tell Ministers on the Front Bench that their colleagues in Whitehall complain all the time about that increase in local authority expenditure. If local authority expenditure continues to increase, they will find themselves being capped, as 19 social services authorities have been capped by the Government. Other people along that ministerial chain in Whitehall have devised the poll tax with the particular objective of making local authority fund-raising as painful as possible, and so making an increase in local authority spending as unlikely as possible.
I warn the Secretary of State that if, during the next few years, the poll tax survives and local authority spending on social services increases by 37 per cent., Downing street will certainly regard the poll tax as having failed. Given that new element in local authority finance, severe and savage as it is, it is unlikely that that upward trend in local authorities' social services spending will continue. If the Secretary of State consults the survey of the Association of Directors of Social Services, he will find that even this year


one third of all social services departments are cutting services because of the financial squeeze caused by the poll tax.
I can forgive the Government for setting aside the views of Labour councils. I can well understand that they must be embarrassed at finding themselves in the company of Derbyshire, stoutly resisting the call for ring fencing, while simultaneously poll tax-capping their allies. But what about the Tory councils? With respect to the hon. Member for Lancashire, West (Mr. Hind), I did not receive a single response from a director of social services from a Conservative-controlled area who was opposed to the principle of ring fencing. Every director in every Conservative-controlled social services authority from which I received a response said that he supported ring fencing. Even the flagships, Wandsworth and Westminster, have mutinied on this issue and stuck to their guns.
In case the hon. Member for Lancashire, West (Mr. Hind) seeks to intervene to prolong my speech yet again, I must point out that not just the directors but Wandsworth and Westminster social services committees concluded in favour of ring fencing. The chair of Westminster social services committee has been to see the Secretary of State to argue the case—[Interruption.] I am merely going by the minutes of the Westminster committee, which I very much hope has not been misled on that point.
The reason why all these councils, including the two favourite sons of the Government, favour ring fencing is not, as the hon. Member for Pembroke (Mr. Bennett) said in an intervention before absenting himself, that those councils do not trust themselves; they all, Conservative and Labour, want ring fencing because they do not trust Ministers. In a bipartisan spirit, I must tell the Secretary of State that they are probably wise to distrust Ministers of both political persuasions because, as those councils know, if Governments can get away with burying the resources for community care beneath the mountain of Exchequer grant, no one will be able to see what is going into community care—

Mr. Peter Thurnham: Will the hon. Gentleman give way?

Mr. Cook: I will not give way again.
The whole point of a ring-fenced grant is to force Ministers out into the open so that everyone can see what they put on the table. Here I must disagree with the Minister for Health. She claimed that ring fencing would not, of itself, guarantee a single extra penny for community care. I am not so sure. I rather suspect that one reason why the Treasury is so anxious to resist ring fencing is that it knows that the moment it comes out in the open the more difficult it will be to resist the pressure to put a realistic sum of money into community care. If ring fencing makes it clear what local authorities are getting, it will also make clear where responsibility lies if those resources are inadequate, and that is precisely why Ministers would run a mile rather than accept the principle.
I have a nightmare—not one of the Secretary of State attempting to run a mile—that in some future year the Secretary of State for the Environment will announce to

the House that, once again, because of the economic climate, it has unfortunately not been possible to increase public spending by as much as had been hoped. Once again it will be necessary to look to local authorities to make their contribution to economic recovery by accepting a reduced revenue support grant. On the same afternoon, over in Richmond terrace, the right hon. and learned Gentleman will pop up at a press conference announcing how delighted he is that the community care element in the revenue support grant has been expanded that year. Everyone will know that that will leave local authorities in an impossible position, once again having to allocate cuts across all the budgets with no prospect of expanding spending on community care or anything else.
Such an outcome would be unfair to local authorities. It would also be unfair to Parliament, which would be unable to pin the blame where it belonged. Most of all, it would be unfair to the people who need community care—to the mentally handicapped, whom the NHS is discharging into the community as fast as it can sell their hospitals; to the elderly, whose only contact with the outside world is often their home help for whom they now have to pay higher charges for reduced hours; and to the carers who look after these people, often providing 24–hour nursing with no training and little support and often as isolated as those whom they look after.
These are not people who can readily fight their corner. They are vulnerable people, not well organised and with no great political clout. It is fitting that Parliament should offer a special arrangement to protect them. That protection should be ring fencing. I urge the House to support the Lords amendment.

Mr. Thurnham: The hon. Member for Livingston (Mr. Cook) did not want me to intervene when he was talking about Ministers coming into the open. He failed to come into the open himself. If some future Labour Government—perhaps part of the nightmare that he talked about—were to go in for ring fencing, how much money would be provided? Would it be enough to satisfy all the needs and would it be sufficient to provide the estimated £24 billion for voluntary unpaid care? That is the amount that Government would have to find to fund all the requirements.
10 pm
The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) talked about spending on the disabled being unpopular. I respect his long experience in this field and we have to accept that in the past that was true, but surely it is no longer true. Now and in the future, the disabled should lobby and form action groups to press for spending. If care in the community means anything, it means that the disabled should press for such spending in their own communities.
The Government are giving responsibility to local authorities. The argument about ring fencing seeks to shirk those responsibilities and difficult decisions, but they can no longer be shut away so that someone else has to face them. Local authorities must face them now. We should not listen to the argument that somehow or other the Government can take care of such matters. Such matters must be managed in the community and local authorities will have to make difficult decisions. They will


have to make balanced judgments, decide on the level of community charge and how much to spend on the disabled and how much on roads.
There is no substance in the argument that money is being diverted from social spending to roads. In my constituency spending on roads has been cut and spending on social services has increased substantially. For certain cases it has doubled. Total social spending by local authorities has risen by 37 per cent. and Government spending as a whole has also risen. There is no way in which sufficient funds can be made available either by Government or by local authorities to pay for the massive amount of unpaid care.
Decisions must be made about priorities so that the people who are most in need of care are given that care. We have seen dreadful cases in the past in which people who were most in need were given the least care. It is the responsibility of local authorities to identify those who are most in need of care, to make the proper assessment and then to assess the priorities. No one is saying that that is easy, but local authorities have been given that responsibility. I did not fully agree with that recommendation in the Griffiths report, but we have decided to give responsibility to local authorities. They should go ahead and carry it out and not think that they can look to the Government to provide some ring-fenced amount to take care of the matter.
It has been estimated that unpaid care is worth £24 billion. Obviously that care cannot be quantified exactly, but it compares with about £6 billion of public funding. There is an enormous gap, and the local authorities must decide how to bridge it. I welcome the suggestion that specific grants should be made to voluntary groups which can organise to provide such care. I suspect that such groups could provide it much more efficiently.
One of the arguments underlying that suggestion is that local authorities do not use money efficiently. The network homes in my constituency cost some £22,000 per year per resident, whereas in a voluntary home nearby that cost is only £12,000 per resident and a higher standard of care is provided. That shows the difference in efficiency in providing care. That is one of the reasons why I do not think that ring fencing would make everything right. As my right hon. and learned Friend the Secretary of State has said, it is for local authorities to be responsible and accountable. We should remember that when we are voting.

Mr. Kennedy: The hon. Member for Bolton, North-East (Mr. Thurnham) will forgive me if I do not follow his line of argument. Indeed, I did not follow his line of argument when it was deployed. In common with the hon. Member for Mid-Kent (Mr. Rowe), I am not entirely sure what he wanted. That merely reflects the difficulty and confusion manifested by the Secretary of State for Health. I agreed with the point that the hon. Member for Wakefield (Mr. Hinchliffe)—who served on the Committee that considered the Bill—made with deadly accuracy towards the end of the Secretary of State's speech. The hon. Gentleman said that, by conceding the need for ring fencing in the cases in his own amendments, the Secretary of State was conceding the principle, of ring fencing. That makes all the more nonsense of the artificial argument that we heard from the Secretary of State. We know that in its heart the Department of Health would

probably like to concede the principle, but that the blocks have been put on elsewhere—elsewhere being Her Majesty's Treasury on the other side of Whitehall.
Towards the end of his speech, the Secretary of State touched on local government finance. He looked as unconvinced by his argument as those of us who will vote in the opposite Lobby to him later this evening. The Secretary of State did not appear to have much confidence in the case that he had to deploy. It reminded me of a description of an advocate who plugged away at the defence of his client when the client had changed his plea to guilty.
In the Parliament of 1983 to 1987, I had the opportunity to serve on the Select Committee on Social Services with the hon. Members for Macclesfield (Mr. Winterton) and for Eastleigh (Sir D. Price), from whom I am sure that we shall hear shortly. It has been said many times, and it was said from the Conservative Back Benches a few moments ago, that the Association of Directors of Social Services would be bound to say that. It is fair to record that any inquiries into the subject carried out by the Select Committee on an all-party basis found that not only those who sought to provide the service and had a vested professional interest supported proposals such as that for ring fencing.
It was clear that voluntary groups, as well as professional groups in the front line of delivering the care services and packages which might be involved, knew that unless the funds were earmarked to some degree, there could be no certainty that the decisions made and the political motivation at the centre would lead to the delivery of services where required, when required and in the form required. More than anything else, that was the motive behind the proposal for ring fencing which is gathering such a head of steam behind it. Those who seek to back up the position of the Department of Health would do well to remember that ring fencing is supported not only because of special pleading. It goes much wider and deeper than that.
The Secretary of State also mentioned the poll tax. In Scotland we have not yet had the delight of safety net arrangements, but in many parts of the country south of the border as the safety net is withdrawn there will be increased and intensified pressure on local authority budgets and, therefore, the spending commitments that local authorities can make. Their commitments will be adjusted to the level at which they can set the poll tax in their community.
Conservative Members should be under no illusion: any Conservative Member whose local authority is inevitably faced with such pressure will not be able to meet the requirements or aspirations in community care. Authorities will not be able to deal with the problems presented to them unless they have some degree of ring-fencing. There will be the bloodbath to try to make sense of the Budget and to keep the poll tax at a politically acceptable level. Yet at the same time local authorities will have to deliver a reasonable degree of service in the community. But that cannot be achieved.
The more voices we hear from the Conservative Benches raised against the position of the Department of Health, the better. I hope that the Department may yet change the proposal in the amendment and extend it. The Secretary of State says that he has conceded the principle.


If he can concede the principle, I cannot for the life of me understand why he cannot accept the logic of that by agreeing to the amendment.

Sir George Young: A large number of my hon. Friends wish to contribute to the debate, so I shall be brief.
I warmly welcome Government amendment (c) to the proposed Lords amendment. As my right hon. and learned Friend the Secretary of State said, a number of us were concerned about the impact of the policy on hostels run by Turning Point and Alcohol Concern. We feared that they would simply close because the local authorities would not place the relevant contracts with them in April next year. Amendment (c) gives them the assurance and the protection for which they have asked, and I am grateful to Ministers for responding. However, the amendment somewhat undermines the Ministers' case against ring-fencing. My right hon. and learned Friend said that it was legitimate to ring-fence for services that local authorities were "inclined not to provide". The fear is that local authorities may be inclined not to provide some of the other services in the Bill unless that provision is also ring-fenced.
My right hon. and learned Friend said that, if we ring-fenced such provisions, we should have to ring fence education and provision for children. The crucial difference, however, is that there are statutory responsibilities in respect of education and children. It must be clearly stated that there are very few statutory responsibilities in the Bill. The Bill contains a large number of objectives for the standard of provision, for co-ordination, for co-operation and all the rest, but places few statutory duties on local authorities. The feeling is that, if adequate resources are not given to the local authorities, the services that we all seek will simply not be provided because they will be squeezed out by other responsibilities that the local authorities have no option but to deliver.

Mr. Robin Squire: Does my hon. Friend accept that the large number of statutory services that exist at present, including education services, have not prevented a wide range of other services from being provided? In each case, the local electors can determine whether they are happy with the level of service. I may even help my hon. Friend's argument, which is not my prime aim, if I point out that many of us would argue that, although adult education is a statutory service, that does not necessarily mean that it is provided.

Sir George Young: I hope later to consider my hon. Friend's valid points.
Initially, when we discussed the matter in Committee, I was wavering; in the end, I voted against the Government. The way in which one votes depends very much on the question that one asks. If one asks what is most likely to deliver effective care in the community, one ends up with the answer, "Ring fencing." If one asks what the conventional means of funding local authorities is, one comes up with the answer that it is not ring fencing. And if one is concerned that there may be some initial disappointment at the level of care that is delivered, one may want not to ring-fence but to put local authorities more in the firing line in future years.
We are discussing a Government policy. The White Paper was a Government White Paper and this is a

Government Bill. We have said quite clearly that we are not satisfied with the standard of care in the community and that we wish to improve it. We wish to drive up the quality of care and ensure that it is effectively tailored to suit individual need. I do not see how one can make that statement and invest political capital in it and then say that, the moment the Bill has left the House, everything will rest on the slender basis of local accountability. I do not think that one can wash one's hands of the policy.
We have an obligation to fund the commitment that we are placing on local authorities by making it quite clear that the resources will follow through. It is all very well my right hon. and learned Friend saying that local authorities' social service departments have defended their corner and protected their client. What constitutes "defending one's clients" to one Department, the Department of the Environment and the Treasury will regard as overspending.
I wonder whether, as more local authorities are poll tax-capped, they will be able to go on defending their corner and protecting their clients. If we move towards poll tax capping, local authorities will say, what are our statutory responsibilities? What are the services that we have no option but to provide? They will focus on those services. They will say that they have no statutory responsibility to provide care in the community and that they do not have the resources for it.
10.15 pm
In Committee my right hon. and learned Friend made a few commitments. He said:
When they have the new revenue support grant, it will be increased by a visible transfer from social security of the amount they would have spent before.
We are moving, therefore, towards the era of visibility. If not ring-fenced, the sum will be identifiable. My right hon. and learned Friend also said that local authorities
will require an additional allocation of resources from central Government, well above what they have had in the past to discharge that responsibility."—[Official Report, Standing Committee E, 20 February 1990; c. 1116–18.]
I agree wholeheartedly. I wish that commitment to be made explicit by ring-fencing it. The suspicion is that, if it is not ring fenced the commitment given in Committee will not be honoured.
My right hon. and learned Friend's case is that we can take the horse to the water but we cannot make it drink. The case that I and others make is that if we put enough fresh water in front of the horse it will drink it. We want to ensure that resources are available to fund this exciting, innovative and radical policy that is broadly welcomed throughout the country. Without ring-fencing, there is a risk that local authorities will be unable to provide that policy with resources and that our expectations will therefore not be fulfilled. That is why I hope that the House will uphold the Lords amendment.

Mr. Ashley: I wish to make a brief contribution on an issue of great importance to the disabled. The Secretary of State made a thoughtful and good debating speech, but he did not persuade me. I am convinced of the need for ring-fencing these funds for community care. The Secretary of State's answer failed to deal with the basic point that severely disabled people are not politically popular. Given their unpopularity, money will not be allocated for their needs. That is why the money has to be ring-fenced.
The Minister for Health said earlier that to ring fence would be to undermine local government. The Secretary of State said that we should not second-guess local authorities. That is precisely what the Government have been doing time and again with their rate capping and poll tax capping. They have been second-guessing and undermining the role of local government. They cannot now hold up their hands in horror and say that local government should be entirely free; that is the exact opposite of their previous actions.
The hon. Member for Bolton, North-East (Mr. Thurnham) conceded that the disabled are politically unpopular but that they should campaign and lobby for funds. How preposterous. Most severely disabled people are too unwell and too preoccupied with grappling with their disabilities to lobby hon. Members. I have urged them to take part in campaigns, but elderly people and those who are severely disabled cannot fight. It is our job—I include the hon. Member for Bolton, North-East—to campaign for the disabled. One of the most effective ways of doing that is to press for funds to be allocated specifically for their needs.
When people speak of local government being responsible, they are talking nonsense. There are both bad and good local authorities. We are concerned with the bad local authorities—the iresponsible authorities and those that make bad decisions. A prime example was referred to on "Panorama" last Monday. A director of social services said that he is cutting social services resources for the elderly disabled and using them instead to combat child abuse. That may be a reasonable decision. We should all do what we can about child abuse, but the fact is that that local authority is thereby robbing elderly disabled people. That is an example of money not being allocated to community care for disabled people because the authority thought that it should go elsewhere.
The answer would be more funds from the Government. The evidence from the Minister's own inspector shows that six local authorities have spent nothing on community care. That is a devastating indictment of the Government's policy of failing to ring-fence. There is no doubt that that is a bogus policy. It would damage disabled people because, without ring-fencing, that money could be spent on all kinds of things such as children, housing tenants, or even fancy bypasses—something which is highly popular and can win votes for a local authority.
The proposal for ring-fencing money for community care for severely disabled people and for old people is important, valid and unanswerable. I hope that hon. Members who believe in campaigning for disabled people will go into the Lobby tonight and support their views and their contentions. If they do not, disabled people will suffer, and the House of Commons could not tolerate that.

Mr. Squire: This is an unusual event. Having heard my hon. Friend the Member for Ealing, Acton (Sir G. Young), it is customary for me to find points on which to agree, but on this occasion I believe that he is wrong. He said that it would depend on the position from which one started. I make it clear that my position is largely as it has been ever since I entered the House in 1979. I strongly believe that local authorities should have maximum freedom to determine their priorities as they see them within a general budget, part of which will be supplied by central Government and part of which they will look to

local ratepayers to provide. I shall often disagree with the way in which my local authority determines those priorities. For instance, I have spent years arguing the case for a greater allocation for adult education, and I suspect that I shall spend several more years arguing for greater allocations for recycling and other environmental issues. That is the nature of the beast. I want local authorities to be given the maximum opportunity.
If local authorities are to be able to take real decisions, such decisions must also include the right to make mistakes. If they cannot make mistakes they are not ultimately given the power to take decisions.
Care of the elderly is important, but so are mandatory education, housing the homeless, and a range of subjects that we rightly expect local authorities to deal with. In those instances, we have not so far said, "You are to have a specific grant for that revenue expenditure, which you must spend on that and on nothing else."
I can understand why Opposition Members support ring fencing if they are strongly committed to and identify with social services and care for the elderly. They do so for one of two reasons. They may fear that they may not get money either from central Government or from their colleagues within a particular local authority. I understand that, but I repeat that their argument is no different from the argument that, if education were ring-fenced at about 70 per cent. or more of a local authority's budget, it would significantly reduce that local authority's ability to take decisions.

Mr. Hind: My hon. Friend mentioned an important point that was made by the hon. Member for Livingston (Mr. Cook), but there is a fundamental flaw. If whatever Government reduced the amount of money made available to local authorities, elderly people requiring residential care would be adversely affected. Equally, the same hard decisions would have to be made for groups with special needs, such as special needs education. A reduction in expenditure would hurt people whose needs are great. Therefore, if one extends the logic of the argument, every local authority budget should be ring-fenced. Surely it must be all or nothing.

Mr. Squire: My hon. Friend may have anticipated my final comments. I agree that this is, in effect, a half-and-half measure.
As ever, the hon. Member for Livingston made an amusing, pertinent and relatively brief speech. I was less than surprised as he reeled off the number of social service directors and committees who, given the opportunity, would like this growing share of their budget to be guaranteed. As a former chairman of a local government finance committee, it came as no great surprise to me. The pressures on leaders of local authorities, who are charged with balancing inevitably conflicting demands, are and always will be hard, regardless of the complexion of the Government or of the authority, but one does not hear them clamouring for the discretion of their authorities to be further reduced. The Association of County Councils opposes ring fencing, and I agree.
My hon. Friend the Member for Ealing, Acton beguilingly said—he almost persuaded me—that the Government had given an undertaking and that this was the only way that it could be carried out. You, Mr. Speaker, have sat in the Chair over the years and heard many undertakings given by Government, many


undertakings given in spheres that I have mentioned and others administered by local authorities. In practice, the Government will provide such sum as they deem reasonable; some local authorities will meet it, some will not and some will over-budget and spend more than the Government allocate.
My hon. Friend the Minister may not agree with my next comments, because I question whether Government can determine need, district by district, as accurately as they should so that the figure produced would be accepted by everyone in every city and town as the right figure. I have never believed that. Veterans of this Chamber will have heard me argue with Ministers when it has been suggested that the Government should be able to do that. If we use the best mechanisms that we have and the most up-to-date forecasts that can be produced, we in Westminster or Whitehall will not know better than people in their respective councils, counties or districts. I believed that when I became a Member, and I firmly believe it today.
The central issue is whether we wish to move further to a system of hypothecated grants or to retain broadly general funding. If one believes in more fixed grants and a system which makes local governments spend 70 per cent. on education and 10 per cent. on social services, as my hon. Friend the Member for Lancashire, West (Mr. Hind) said a moment ago, logically one should press for that across the spectrum and say, "That is how grants should be made." If one does not, one should, with respect to their Lordships, resist the Lords amendment.

Mr. Hinchliffe: The central issue that we must address tonight is how we can expect local authorities properly to plan for the changes included in the legislation, without the guarantees that would be provided by ring fencing.
It is important to stress that the majority of local authorities that will face the task of implementing the legislation are in utter chaos as a result of the introduction of the poll tax, the threat of poll tax capping and the fact that they already cannot meet their statutory social services obligations. It is nonsense to suggest that local authorities have no idea of the budgets that they will have to implement these provisions. The standard spending assessments bear no relation to local authorities' requirements.
We must consider the adequacy of the present funding for community care. To ring-fence next to nothing still leaves a local authority with next to nothing. To ring-fence inadequate social services budgets will not enable local authorities to meet the needs that they are required to meet, especially as they will face increased demand.
Wakefield will have an enormous problem with its social services budget because the SSA for the current financial year is £4,268,000 below the budget. In the words of the director, it is "nowhere near enough" to meet daily needs. The Government talk about the great things being in store for those who will receive community care, but to achieve its SSA, the district council would have to cut one fifth of its existing budget. The director would have to make cuts, had he not had the support of the local authority to defend his corner, involving the loss of nearly 600 care staff who are the direct providers of statutory

social services care, the closure of four homes for elderly people in Wakefield, the possible closure of two children's homes and the closure of a home for the mentally handicapped. As Mr. Lane said, Wakefield district council could not fulfill its statutory responsibilities. Yet the Government say that the figure is appropriate for my local authority's budget.
The council would have to put juvenile offenders in prison, and children with mental handicaps in hospital, and many children who require statutory supervision because they are at risk could not have a social worker allocated to their case. How on earth can anyone defend such an SSA? I should like to see the people who define these regulations and assessments beg for a place in a home for their elderly mother or relative who cannot cope. That is what is happening.

Mr. Ian McCartney: The picture that my hon. Friend paints is horrific, but it is the norm in a key number of local authorities. More than 20 local authorities, including my own, are being poll tax-capped simply for providing care at statutory care level. They have been attacked by the Secretary of State for the Environment for doing so and are having to take millions of pounds off their current budgets for the provision of statutory social services care. Unless there is ring fencing, local authorities that are prepared to provide care up to the limitations of statutory provision will be penalised because, having provided care, another department will be constrained by another piece of legislation. Unless the Secretary of State resolves that, more local authorities will be poll tax-capped simply for meeting the requirements of legislation produced by the Secretaries of State for Health and for the Environment and for not cutting their budgets.

Mr. Hinchliffe: My hon. Friend is right. He has first-hand experience of poll tax capping in Wigan. I have never regarded Wigan as a particularly extravagant authority. The people of Yorkshire were shocked and amazed when Barnsley and Calderdale were included in the list. No one could suggest that those authorities are overspending or being over-generous with their provision.
In Wakefield, the projected figures for the needs of the area in the next financial year, including the costs of implementing the Children Act 1989 and this legislation, and the introduction of the NVQ scheme, will involve a difference of £30.5 million between the SSA which the Government provide and the actual budget. I honestly do not know where the cuts in provision will be made. My authority spends 20 per cent. below the average metropolitan authority. It is a low spender when compared with other authorities.
There is a need for stability in the funding of community care. Local authorities want to know where they are going and how much they have to play with when they are planning services. They do not want to have to guess about their provision at the last minute. It makes no sense to have an SSA that bears no relation to the needs and statutory responsibilities of local authorities.
I want to broaden the debate. As I stressed in Committee, we need a major shift in the direction of funding away from institutional care towards community care. We can guarantee that only by the provisions in this Lords amendment. We must ring-fence the provision that


allows us to consider the alternatives to traditional measures. According to the traditional provision, when granny needs care, she is shoved into a home.
Members of the Select Committee on Social Services recently visited Europe to consider the alternatives to our traditional provisions. We must get away from the tunnel vision in which our only response to meet the needs of the handicapped, the elderly and those with special needs is to put them into homes. To achieve that change we must have direction and planning of community care.
Under this Government, there has been a complete absence of planning and direction of community care. The Government have been prepared to abrogate their responsibility and to leave it to the market. The market has not provided what the service users want. Instead, entrepreneurs and business men provide what they believe they can make money from. I believe that a vast sum of money—up to £1 billion—has been thrown away on creating institutional provision which is not what people need.
We must divert that funding towards preventing people from entering institutions. We should not be actively encouraging them to do that through the open-ended financial support that is proposed. When the Minister of State responds, she may say that the Government have changed the scene by introducing assessment and case management. That is the point that the Secretary of State made earlier. It is all very well to say that we have assessment in case management, but a social worker assessing someone in need can make care recommendations only on the basis of the services that are currently available.
We should be investing in alternatives in the community that are designed to keep people out of homes. The Government have diverted funding away from preventive services and shoved them into the open-ended commitment to private old people's homes. The only option for the vast majority of people is a home, because there is no support for them to remain in the community.
We should completely change the direction of funding on community care. We need a new radical agenda for community care and I hope that that will be introduced by the next Labour Government very soon. The central commitment of that agenda will be to enable people to remain in their homes. It will invest in keeping people in the community instead of removing them from it. That will entail a complete redirection of public resources to the prevention of need in the community instead of actively encouraging institutional care.
Last week, the Minister of State attended a conference at which I too was present. Unfortunately, she did not hear a contribution in the morning from a lady called Rachel Hurst, a disabled person who is probably well known to many hon. Members of all parties because she is active in the British Council of Organisations of Disabled People. With respect to those hon. Members who also made speeches, I think that that lady made the most telling point of the entire day-long conference, when she said that the central issue was the
need to change the priority of allocation of resources to independent living.
That is the challenge which the Government have ducked.
The change in direction can take place only if we have guaranteed resources to enable us to invest in alternatives to institutional living. In that context, Lords amendment No. 70 is absolutely essential.

Sir David Price: I very much regret the fact that we are having this important debate in the terminal moments of the Bill's passage through Parliament. Those of us who serve on the Select Committee on Social Services produced a report on these matters for this House, not another place, before the Report stage, but it was never discussed because the appropriate new clause was not reached because of the guillotine. I hope that hon. Members have read our report, because I stand by it. I think that their Lordships did so, too, and I believe that it inspired their amendment No. 70.
The House will not be surprised to learn that I shall be speaking in favour of the amendment, because I stand by the report that the Select Committee prepared with great care. As the House knows, I am rather old-fashioned and I believe that it is a matter of honour that one should vote on the Floor of the House exactly as one has voted upstairs, which is what I shall do tonight. I do not apologise to the Government Front Bench for being a man of honour.
The issue is simple: should grants voted by Parliament to local authorities to help them to fulfil their community care function be specific, and therefore identifiable, and therefore earmarked, or should they be simply an enhanced element in the standard spending assessment? In his effort to persuade the House that this is the right route, my right hon. and learned Friend did not give us any information about how the SSAs are to be altered to take into account the enhanced role of care in the community.
My hon. Friend the Minister for Health will remember a happy little debate that we had when she was in a different Department, which ended with me voting against the Government on their support rate grant formulae. We went into four or five decimal places and I made a little fun of the arithmetic because it was incomprehensible. I believe that we are in danger of getting into the same position now. Frankly, I am not satisfied that the enhanced role that this House is agreed upon for care in the community will, in terms of resources, be taken care of in the SSAs. We have heard nothing on that tonight.
In a moment of total generosity—it is the Queen Mother's 90th birthday—I offer the David Price prize for comprehension to any hon. Member who, before the debate is over, can catch your eye, Mr. Deputy Speaker, and explain in simple language how the SSA formula will be altered to accommodate care in the community. That offer stands. Indeed, I shall withdraw my opposition to the Government's objection to the Lords amendment if, when my hon. Friend the Minister replies to the debate, she can do what she was unable to do—I say that with all my normal generosity—a few years ago when I attacked the old rate support formulae. That is a fair offer, is it not? If they cannot do so, I invite the Government to rethink their position and to join those of us who are the vast majority of thinking people in these matters. After all, this is not a matter of deep principle; it is a matter of practice.
My right hon. and learned Friend the Secretary of State went a little further tonight, and we welcome that. He is to include alcohol and drug abuse within the provisions. When he says, "The mentally ill are separate," hon. Members may well ask, "Why not the mentally handicapped?" What distinction is there? At what point does someone with Alzheimer's disease cease to be geriatric and become mental? I know that an elderly

person with dementia has problems, but to distinguish whether that person falls into the category of the mentally ill or the geriatric is a difficult decision.

Mr. Rowe: If the Government ring-fence services to drug addicts and alcoholics, they will receive the money, but if the Government ring-fence the entire social service budget, how will those individuals who need to be protected within the local authority budget get the money?

Sir David Price: My hon. Friend is advocating an admirable reason for detailed ring fencing. I know that he will have read our report and will know that we offered the Government and the House five different options. At this late hour I shall not take the House through the report, but I assume that my hon. Friend, with his normal application to such matters, has studied it. After the debate, I should like to talk to him about which option he prefers. My hon. Friend has gone further than me by arguing for detailed ring fencing. If one is thinking in terms of the Cinderella services, a case can be made along those lines.
There is nothing new in the concept of care in the community—it has been with us since the beginning of settled communities. What is new is the higher profile attached to it by the Government, which is absolutely right. If such care is to receive a higher profile, however, the natural concomitant conclusion is surely that one must provide the resources to do so.
We discussed choice in the sixth report of the Select Committee. We quoted a number of local authorities who believe that, while that choice is a lovely idea, if they do not have the resources to provide it, what does it mean? We can all go to the Ritz, but if one does not have the money to buy tea there, what is the use of going? In those circumstances, one's choice is theoretical. The same is true of community care.
Resources for community care have always come from a variety of sources—and let us not forget the voluntary sector. That variety of sources will remain, but germane to our debate is that amount of central Government money that hitherto came from the Department of Heath. What will happen to that money? That is the core argument. One could consider the totality of current expenditure, but we are specifically concerned with the amount that comes from central Government.
In the circumstances, it is worth considering all the representations that the Select Committee received from the voluntary and professional organisations. The views of the Queen's Institute of Nursing, which represents district nurses and community nurses, are probably even more important than those of the Royal College of Nursing. That institute is clear about what it wants to see.
I am sorry that my right hon. and learned Friend is no longer present as it is important to note that the local authority associations are in favour of ring fencing. The Association of Metropolitan Authorities said:
The Griffiths Report recommended ring-fenced funding for Community Care and the Association supported this proposal.
The Association of County Councils appears to have undergone a sea change since it gave evidence to the Select Committee. The hon. Member for Preston (Mrs. Wise) quoted the initial part of its evidence. It went on to say:
Community Care resources must be actually available to individual social Services Authorities. This implies the separate indentification of resources for individual authorities and it implies the need for a suitable distribution mechanism.


I am astonished that the Treasury is not in favour of specific grant and ring fencing—I am delighted to see my right hon. Friend the Chancellor on the Front Bench—because, from the point of view of accountability, the money voted by Parliament for community care is spent on what we voted for. I should have thought that my right hon. Friend the Chancellor, the Audit Commission and the Public Accounts Committee would agree that what we are suggesting—a specific, ring-fenced grant—would provide that accountability, which would not be achieved in the alchemy and mysticism of the SSA. The David Price prize for comprehension of SSA remains on the table until the House rises tonight. I hope that the Treasury will reply to my questions.
I believe that it would be correct to follow the advice of the Select Committee—if that does not sound too conceited coming from a member of it—the advice of their Lordships—everyone loves a peer—and the advice of every voluntary and official body in the country. I invite my right hon. Friends on the Front Bench to join the mass movement in favour of care in the community. I hope that, on reflection, they will remove their objections and that at 12 o'clock we shall conclude our discussions without a vote, all agreeing that their Lordships were right.

Mrs. Wise: Having listened to the speech of the hon. Member for Eastleigh (Sir D. Price), I can abandon quite a few of my remarks, because he has explained so clearly the thinking behind the Select Committee report. However, it is probably worth reminding the House that the Select Committee report was unanimous. It was not produced capriciously; the Select Committee has taken a vast amount of evidence. We are still taking evidence and people are still talking to us about ring fencing. No doubt the hon. Member for Maidstone (Miss Widdecombe) would prefer that I make it clear that she was absent, but the rest of the Select Committee speak as one on the issue. That is significant, because I and my colleagues on the Select Committee do not agree on the generality of political matters, but on these issues we have been driven by the evidence before us which was so compelling.
Tonight, we have heard a great deal about freedom for local authorities when local authorities are under more pressure than ever before. My right hon. Friend the Member for Stoke-on-Trent (Mr. Ashley) referred to bad local authorities. However, with all due respect to him, that is not what we are discussing. We are acknowledging intolerable pressures on local authorities which are due in no small measure to the actions of the Government.
The Secretary of State spoke about making responsibilities for community care clearer, but we are not discussing making responsibilities clearer but putting extra responsibility on to the shoulders of local authorities and then being unwilling clearly to identify the funds which should accompany those responsibilities.
The Select Committee did not hesitate to say:
we fear that local authority budgets for community care will be inadequate. One reason for this is the potential carry-forward of the current inadequate level of Social Security spending on residential care to local authorities' budgets for community care.
Presumably, later tonight, we shall have the opportunity to vote on the inadequacy of funding for residential care.
The Select Committee is in no doubt that the budget for community care will be inadequate. Much has been made

of the Association of County Councils, and I am sorry that it gave contradictory evidence. However, I remind the House that the ACC told the Committee:
It is unlikely that the resources eventually identified by Government as the care element within the present income support allowances will begin to meet the additional cost of implementing the White Paper proposals.
That is a strong quote. It is saying not that the money will not finish the job, but that it will not even begin to meet the requirements.
The Association of County Councils is not dominated by Labour members. Therefore, as—I almost said my hon. Friend—the hon. Member for Eastleigh (Sir D. Price) made clear, there is a mass agreement that the resources allocated to community care in pursuance of the White Paper should be protected, adequate and clearly identifiable, but none of those criteria will apply. The Government will have a convenient mechanism to say to local authorities, "Here is the job." They will tell the public that they are transferring resources for it, and then allow those resources to be swallowed up in the intolerable pressures on local authorities at present.
It is not even that the money may be used for education or other worthy objectives. Local authorities may be forced by Government action to use the funds to reduce the poll tax. There will be no protection against that. If the Government are serious in wanting an advance in community care, they should heed the words of the Select Committee, on which their Members have a majority, and the Lords amendment, which they should support.

Mr. Jack: I have listened carefully throughout the debate to the remarks made by Opposition and Conservative Members, and I am singularly amazed that we seem to be beginning to think that all problems in community care can be dealt with simply by ring-fencing a budget. It is far more important to discuss the quality of service of community care that can be delivered to elderly, mentally ill and physically handicapped people. That has a great deal to do with the quality of the management of social services in this country, not simply the mechanism by which a line is drawn round a number on a piece of paper.
I served for some time on the Mersey regional health authority and I distinctly remember that we had a debate about how to protect an element of the budget that we wanted to develop for services in the community. The choice as to how we protected that was determined by that health authority. We said that we would protect a certain element of the budget by ring fencing, but it was Mersey regional health authority's choice that we should do that. I do not understand why it is illogical to suggest that a responsible local authority would do the same.
One of the most powerful points today was made by my right hon. and learned Friend the Secretary of State, when he said that under the provisions of the Bill local authorities will be required to draw up a community care plan which will be open to inspection. That means that it will also be open to discussion. I am sure that some Opposition Members will join in the vigorous local debates which will place about how the priorities for care plans will be determined. That is the most powerful way in which local authorities can be compelled to carry out the responsibilities in their districts. That is what choice, debate, accountability and local democracy is about. All that we hear from Opposition Members is that, if the budget is ring-fenced, all those problems will be sorted out.
We have heard about the directors of social services. Those good people argued powerfully for the provisions of the Bill. They argued powerfully against the health authorities that they should have the responsibility for delivering care in the community. Ultimately, supported by Sir Roy Griffiths, the Government agreed with that point of view. The directors of social services argued that because they thought that they were in the best position to deliver that service. We have heard today that they are so in tune with their local authorities that they have written in large numbers to the hon. Member for Livingston (Mr. Cook) committing themselves to the concept of ring fencing.
11 pm
The directors of social services may be wrong, and they will probably lose the intellectual argument, but have they completely lost their powers of advocacy with the local authorities? We are told that they can carry the local authorities with them on ring fencing, so why cannot they carry the local authorities with them when it comes to seting the priorities for care? It would be a bold local authority which would completely abrogate its responsibilities in that area by pillaging the community care budget for a range of alternatives. I suspect that the pressure from the community will be the other way, and that the social services budget could benefit from savings in other parts of local authority budgets.
Those who advocate ring fencing have missed another dynamic. Let us consider, for instance, the situation where a facility for the mentally ill was being developed, perhaps a day care centre, which needed an access road. If no money was available in the highways budget for that, ring fencing—under the rigid terms proposed by the Opposition—might prevent a small transfer of resources from the community care budget to the highways budget to build that access road and thus enhance community care.
I may have had a go from time to time at my local authority in Lancashire because of the way it carries on, but at least it makes a genuine effort within its limited resources to carry out its social service responsibilities. So far as I can see, however, the quality of its ability to deliver that care depends far more on the skill of the managers and their perceptions of the particular problems than on the ring fencing of the budget. Ring fencing will not add to the efficient delivery of the service.
There is a strange view that ring fencing will overcome certain problems. I could understand that if the debate had been about the sum total of the community care budget and our social services, but it is not—it is about the mechanism for administering it.
The fundamental question is whether we trust local authorities to deliver the services. I am staggered by the Opposition's argument that on such a major programme local authorities could not be trusted to fight for the needs of local people. This is a real chance for local authorities to rehabilitate their image and prove that they can be responsible and accountable in delivering those services. That will be achieved by pressure from the local communities, not by ring-fencing particular budgets.
We live in an age of exciting opportunities in community care, but they will not be realised by ring-fencing the budget.

Mrs. Rosie Barnes: I hope that I quote the Minister for Health correctly when I say that, speaking to the Select Committee on Social Services, she said:
Ring-fencing … leads to … conservative, reactionary, fossilised provision of services.
I would say that it would result in the sensitive, effective targeting of services. It certainly will not solve everything, but it would be a major step in the right direction. Without properly directed funding, community care may be no more than fine words.
While responsibility for care in the community is to be transferred to local authorities, proposed changes to income support and housing benefit for those in residential care homes and nursing homes are to be left to future legislation. According to the White Paper "Caring for People", local authorities may enter into contractual arrangements with independent providers and negotiate a price for a specific number of places, and the cost will be met by social services departments. Many places will be for the elderly; others will be for the mentally ill, the mentally handicapped and the physically disabled. Social services departments will have to estimate the likely demand for such places and assess the income of people who they have deemed will need such residential care. People receiving income support or housing benefit will have to hand over those benefits to social services departments, except for a small amount for their personal needs.
So far, so good: but no person in residential care should be better off than one cared for at home. That was an explicit intention of the Bill, and one with which I agree. However, having taken a person's income support and reimbursed the home up to the negotiated amount, the Government then say that the preferences of relatives and other carers should also be taken carefully into account. Unfortunately, that means that their financial cicumstances should be carefully taken into account.
The White Paper goes on to say:
If relatives and friends wish, and are able, to make a contribution towards the cost of care, an individual may decide to look for a place in a more expensive home.
Fair enough, but only as long as the basic provision is suitable and of a high basic standard.
Unless we have ring fencing, we run the risk of local authorities, under considerable financial pressure, choosing the cheapest homes available, and people will have to accept them because there is no alternative. Or, even worse, authorities will not be able to afford enough places, so many people needing residential care will have to remain at home by default because that will almost inevitably be the cheapest option.
Earlier, it was claimed that ring fencing would not be restrictive. I say that it would be: to restrict the money allocated for this purpose to the very people for whom it was intended is restrictive, but it is quite right. Without such ring fencing, community care and those in need of it would be in peril, and the provision of earmarked grants goes some way towards ensuring a minimum level of provision. That is all that we can expect.
It is not complicated to direct that the additional amount provided should be made specifically available for a certain purpose. I suspect that the amount of that money is at the root of the debate. If the amount can be concealed in the total grant, local authorities will carry the responsibility, not the Government.
There is no reason to encourage the perverse incentive to take up residential care rather than stay at home


because of a financial inducement. But tonight we may be encouraging an alternative perverse incentive—obliging people in need of residential care to stay at home because the care is not available due to lack of resources or to a failure to earmark the resources.
Another great danger of this part of the Bill—it becomes all the more apparent without ring fencing—is that the professionals will make all the assessments and decisions. The people on the receiving end will have no choice, because the money will dictate what is available.
It is not a case of all or nothing. The Government have made it clear that they favour ring fencing in certain circumstances: for the mentally ill and for those with drug or alcohol problems. Recently, and in quite a different area, I had cause to make representations to the Home Secretary on behalf of the police, because savings in one department were not allowed to be transferred to another department in the police service. Ring fencing applies when it suits, but it does not suit on this occasion. We must inquire into that in more detail.
We are talking about provision that is already inadequate and at risk. In my constituency there is a two-year wait for an occupational therapist from social services to visit for an initial assessment of what is needed. That is for people who are severely ill with illnesses such as multiple sclerosis or who are suffering from the severe effects of a stroke. That is a two-year wait only for assessment, not for the treatment to be made available.
A resource centre was built in Greenwich for the physically disabled. People in a specific area agreed to forgo their children's playground in the interests of that centre. Because of lack of money within social services, the centre never opened and after being vandalised and refurbished at considerable expense, it was handed over to the directorate of housing for use as a hostel for the homeless. I would prefer it to be used for something rather than left empty, but that is an example of the decisions presently being made at local authority level.
All too often it is the disabled and the elderly—those who are in need of community care—who are the bottom of the pile and suffering. We must speak out for those people and I hope that, in winding up, the Minister for Health will reconsider this vital matter.

Mr. Robin Maxwell-Hyslop: The Government Front Bench is rightly known as the Treasury Bench. The problem is not about good or bad local authorities, but that the Secretary of State for Health is himself ring-fenced. Other Ministers pour out legislation which imposes new statutory obligations—not discretionary duties—on local authorities. That is the nature of the problem. Even in the social services budget of many local authorities, an ever-increasing proportion—not just amount—has to be spent on meeting the new legal requirements of core cases. For example, the Children Bill has just gone through the House. As its requirements are mandatory on local authorities, in a sense they are ring-fenced. Those expenditures must be met. Another example is the national curriculum, the expense of which has been grossly underestimated by the Government.
We all know the phrase "taken into account". It does not mean "paid for". When new duties are imposed on local authorities we are assured that those duties will be taken into account the next time the standard spending assessment is calculated. It never means paid for. It always means a still greater claim on the resources of local

authorities which is outwith the discretion and the priority judgments of the councillors who are elected to take decisions. Therefore, the Government constantly carry out ring fencing through the imposition of new statutory duties. It is that as much as anything which makes it necessary to ring-fence these functions of local government to protect it from the statutory obligations imposed by other Ministers.
The history of joint funding between the national health service and local government is certainly not a basis for confidence that ring fencing is unnecessary. In Devon, the area that is within my own knowledge, grant started a t 100 per cent., then became 50 per cent. and then became zero, and the lot had to come out of the resources of the county council. That is the pattern that we have seen so often no matter which Government are in office. The case for ring fencing does not impute incompetence, lack of good will or unwillingness by local authorities to take difficult decisions. All those allegations have been made this evening by those who are opposed to ring fencing.
11.15 pm
It must be acknowledged that local authorities are overwhelmed with statutory duties, and these duties continue to pour out from this place. My right hon. Friend the Prime Minister told me in a letter—as it is not marked private and confidential, it is a public document—that my right hon. Friend the Secretary of State for the Environment, not my right hon. and learned Friend the Secretary of State for Health, is responsible for monitoring all additional burdens that are placed on local government by central Government. I do not believe that he carries out that responsibility. I do not believe that he is capable of doing so.
Does my right hon. Friend have interdiction over new legislation on the inspection of food? Of course he does not. Indeed, my right hon. Friend the Secretary of State for the Environment is imposing new duties on local authorities that can be enforced by suing through the courts if there is garbage to be seen around. That is admirable environment protection, but the cost of it in rural areas, which spread out over a huge number of miles of road, could absorb the entire security budget unless there is ring fencing.
It is as much to protect my right hon. and learned Friend the Secretary of State for Health and his intentions from the actions of other members of the Government that we owe it to him to insist that Lords amendment No. 70 be upheld.

Mr. Kevin Barron: I was not a member of the Committee that considered the Bill, but I have watched its passage with some interest. I am interested especially in the funding of community care.
About 18 months ago, my mother-in-law died of Alzheimer's disease. The disease took over when she was in her 50s, and initially she was protected by her family to the greatest extent possible. Anyone who goes through the experience of looking after someone who has the disease knows that it is a traumatic time. That applies to the household and the wider family.
My mother-in-law went into an admirable private home in a neighbouring constituency. My wife and I visited dozens of homes to try to find one that could adequately look after her. Psychiatric help in private nursing homes is rare, and I am sad to say that my


mother-in-law spent only a short time in the home. It was found that poor Nancy was disturbing others who had various forms of senile dementia and were not as active as she was. Consequently, she had to return home to be looked after by the family.
There were fortnightly periods of respite care when Nancy went to the local hospital. Those periods helped the family and, in a sense, many others. Nancy eventually went into long-term care within the area health authority, and died, sadly, nearly two years ago.
Before the events which I have outlined, I had discussed similar problems with my constituents, but I had never understood the true nature of them. I have a list in my office of other Nancys. They are at home and their families are still waiting for respite care for a couple of weeks. Those Nancys and their families are still waiting for long-term care within the area health authority.
The crisis had become embedded even before my personal experience. It is not the AHA's fault, because its resources are limited in this sector as they are in acute services. I do not know where acute services begin and end. It is not the fault of community psychiatric nurses, whose work load is far too high. It is not the fault of the social services. They do all that they can to help people who find themselves in circumstances similar to those experienced by my family. Some hon. Members have no knowledge of the true position.
About 12 months ago we hoped that some help would be forthcoming. Rotherham health authority was converting a maternity hospital in a neighbouring constituency into a home for the elderly which would have provided respite care for their families. However, the authority found earlier this year that it did not have sufficient resources to complete the conversion. The project will eventually be completed, but it will provide no relief for those who are now looking after elderly relatives. I have visited a number of homes where I found that some elderly people do not even recognise the members of the family who are looking after them. It was a joint project, funded by the health authority and Rotherham metropolitan borough council.
My brother is a councillor and sits on the social services committee. He understands the problems in his area and the implications of the lack of funding of community care. He knows that families desperately need care of that type.
The funding was withdrawn so that Rotherham would come within the original poll tax that was set for it. Today my authority lost its appeal in the High Court. It has been poll tax-capped to the tune of £7.9 million. That will lead to further cuts, both in my constituency and in other constituencies with similar problems.
Conservative Members say that the Lords amendment would lead to everything being ring-fenced, but we do not need to ring-fence education. We have not even begun to understand community care problems. The Bill as it stands provides us with an opportunity to do something about it. It is naive to say that the ring fencing of community care would lead to all other local authority expenditure being ring-fenced. The other place has produced a sensible amendment by saying that money should be ring fenced for community care. What does the standard spending assessment provide for people who are experiencing this

terrible problem? I hope, therefore, that hon. Members will support the Lords amendment. It is the only way to tackle an urgent problem.

Mr. James Couchman: The resources to be transferred to the local authorities are at present the resources of my ministerial master, and the conventions of the House in that regard led me to hesitate to participate in the debate. Having listened to Opposition Members' speeches, however, I feel it essential to say that I am astonished that they should be demanding the ring fencing of the transferred resources. I well remember, as a young chairman of social services serving on the London Boroughs Association, listening to that great doyen of London Labour politics, Sir Lou Sherman, talk of the rabbinical doctrine of non-specific grant and non-hypothecation. I remember just how precious was the principle that grant should not be ring-fenced as suggested in the Lords amendment.
To demand ring fencing shows a complete disregard for, and distrust of, local authorities. If I were cynical, I would say that the policy of ring fencing would allow local authorities to cease to spend the local resources that they spend on community care at present. It would allow them, perhaps, to transfer the cost of the home help service, or—the home care service, as it is in my county, and of meals on wheels—two services which represent community care at its best. If those costs were transferred, why should not local authorities transfer out of the local government budget the cost of social workers who work with the elderly?
I was amazed to hear the hon. Member for Preston (Mrs. Wise) suggest that local authorities might be pleased to use the money that is to be transferred to reduce their community charge.

Mrs. Wise: Will the hon. Gentleman give way?

Mr. Couchman: I shall not give way, because the debate is coming to an end.
I agree with my hon. Friend the Member for Hornchurch (Mr. Squire) that we have constrained local authorities too much in recent years. My hon. Friend the Member for Fylde (Mr. Jack) spoke of the faith that we should be placing in local authorities by transferring these responsibilities to them. We should let them be the lead authorities, and we should allow them some freedom in the way in which they manage the services.

Mr. McCartney: Talk some sense.

Mr. Couchman: Perhaps the hon. Gentleman would care to listen rather than talking through every speech that is made.
If we ring-fence this item, we may as well ring-fence every local government service. If we do that, we shall end up running local government from Whitehall, and we might just as well do away with all the social services authorities and with local authorities generally. The Government are entirely right to resist ring fencing, and I certainly have no difficulty in disagreeing with the Lords amendment.

Mr. Ieuan Wyn Jones: I am pleased to be able to participate in the debate, not least because the Lords amendment was piloted through the other place by Lord Allen of Abbeydale, who skilfully piloted my private Member's Bill through the House of Lords last year. If the


success that was achieved on that occasion is to be repeated, we must hope that the House will accept the amendment.
The Government's main objection to the Lords amendment is that it would affect the decision-making powers of local authorities and remove their discretion to act. That comes a bit rich from a Government who have attacked local government services over the past few years. They have stripped local authorities of many of their powers. They have centralised their decision-making powers and curbed their right to raise finance.
I have not heard howls of anguish from local authorities that ring fencing would curb their powers. On the contrary, most local authorities—and especially the departments that would be particularly affected by the provisions—welcome the idea of having a defined sum of money which they know will be available to spend on care in the community.
In an interesting speech, the hon. Member for Hornchurch (Mr. Squire) said that local authorities should be given the responsibility to decide their own budgets, even if it involves making mistakes. We cannot talk about making mistakes in a vital service such as community care. Over the years, many mistakes have been made in the provision of community care, and they have affected people's lives. It is often a matter of life and death.
11.30 pm
It is not a matter of educating people; it is a matter of whether people live or die and whether the care that they are given will prolong their lives and enhance their quality of life. It is as important as that. That is why the case for ring fencing is unanswerable. We are talking about people's fundamental right to comfort and dignity.
Social services departments are under tremendous pressure. Day after day, statutory responsibilities are imposed on them, whether under the Children Act 1989 or the Education Reform Act 1988. All those responsibilities have resource implications. We must remember that, in the days of poll tax capping, local authorities will be put in the invidious position of having to make decisions and choices. We should not put them in that position. We should allow them to know exactly what resources are available to them at a given time.
Voluntary bodies that are responsible for the delivery of community care would welcome ring fencing. They know that, if they are properly to deliver care, they must know what resources are available at the beginning of each financial year. They must also know what resources are available to train volunteers to discharge their new responsibilities.
I suspect that the real reason why the Government do not want to ring-fence community care is because the sum would be in the open and we would all know what the Government propose to spend in a certain year. We would then be able to identify the cash that would be allocated. The Government's problem is that we would then know that the allocation would be totally inadequate.
It is not right that the Government should adopt a Pontius Pilate approach to local authorities and say, "Here is an amount of money for you. You spend it in the way you think desirable." It will not work like that. The case for ring fencing is unanswerable. The most trenchant and compelling case for ring fencing was made by Sir Roy Griffiths in his report. The Government refuse to accept

that recommendation, because of the resource implications that it involves. If the Government and the Treasury are not prepared to accept that recommendation, I hope that hon. Members will support it.

Mr. Roger Sims: I hesitate to trespass on the limited time to discuss this matter, but I am especially concerned about it. I was a member of the Standing Committee and also a signatory to the Select Committee report. I am concerned about the lump sum that is to be transferred to local authorities which are having great difficulty in planning to implement the Bill without knowing what money they will have to do so.
In response to the Select Committee's second report, the Government specifically said:
It has always been the Government's intention to calculate and transfer to local authorities the amount of social security expenditure that would have been available as a contribution to the care costs".
That would suggest a straightforward calculation. In reply to my recent question, the Secretary of State said that the figure will not be available until the end of the public expenditure round. It is nothing to do with the public expenditure round; it should be possible to calculate the figure exactly and to give local authorities some idea of the sums that will be available.
Having listened to the ring-fencing arguments advanced in Committee and on the Floor of the House, I find them fairly evenly balanced. In favour of ring fencing is the argument that local social services committees will have adequate funds to carry out their responsibilities, and that, without it, funds allocated by central Government may be used for other purposes, which may or may not be less worthy than community care.
The argument against ring fencing is that, as my hon. Friend the Minister said, social services committees fight their corners pretty well and usually get a pretty good share of the local authority budget. If money is ring-fenced, when proposals are made by social service committees, local authorities may say, "You have had your lump sum; that is what the Government said you can have, and we are not willing to allocate further funds."
Another argument against ring fencing is that it restricts local authorities' initiatives. When proposing ring fencing for community care, one must specify precisely what is meant by community care, because otherwise it is meaningless. That must, by its nature, be restrictive.
People hold different views on the issue. In the past couple of days, I have spoken to two directors of social services who do not advocate ring fencing. They have many bright ideas and initiatives that they want to, introduce under the flexibility that the Bill offers, but they fear that ring fencing may restrict what they can do.
A few days ago, I was talking to some housing association officials, who said, "I hope you will not support ring fencing," and proceeded to tell me about certain housing initiatives that they want to implement. They fear that ring fencing would have to be so specific that they would not be free to implement those proposals.
The hon. Member for Preston (Mrs. Wise) referred to some of the schemes that the Select Committee on Social Services saw abroad. They were interesting, and no doubt they will feature in our reports. Will they fall in the precise categories of ring-fenced community care that will be laid down if the Lords amendment is accepted? I give only one example. It was interesting to find that community care officers in Italy give old-age pensioners allotments. They


think that it is rather a good idea, and therapeutic, for elderly gentlemen who live in flats in towns to be bussed out to their allotments. I think that we probably agree that it is quite a good idea, and it would certainly fall within our idea of community care, but would it be specified in the legislation?
The danger is that some good ideas may be advanced, and many people may say, "That is what we mean by community care," but they may not meet the requirements for ring fencing. I should have been happier if Ministers had been more forthcoming about the sums that will be available to local authorities and had assured us that they will be adequate. However, it can be argued that, within the philosophy enshrined in the Bill, there should be flexibility for local authorities in administering community care and, in the circumstances, I am willing to give Ministers the benefit of the doubt.

Mr. Tom Clarke: This interesting and, in some ways, compelling debate has reflected the opinion of many parts of the country. Hon. Members on both sides have given clear support to the House of Lords decision and the view of many important bodies and, in particular, of Sir Roy Griffiths that we shall not get these matters right unless we take on board the important principle of earmarking the inevitably limited resources available. I am sure that my hon. Friends will agree that the hon. Members for Eastleigh (Sir D. Price) and for Tiverton (Mr. Maxwell-Hyslop) put the case clearly and strongly without any element of overstatement. What they said invited the support of the majority of the House.
The issues are so grave that the House, in the latter stages of considering the Bill, would do a grave disservice to the Griffiths report if, while we endorsed the principles and accepted that something should be done about the cares which the Audit Commission and Sir Roy Griffiths identified, we pulled back from the inevitable conclusion that the resources which are supposed to be made available for the most vulnerable people in our society were in some cases being spent on other purposes. That would be indefensible.
There is no challenge to a principle which the Government have said is sacred. They have already accepted that a clear case exists for earmarking funds for the mentally ill, and for drug abuse and alcoholism. We are arguing that the evidence is so overwhelming that there should be ring fencing for community care and that the House has an important responsibility to respond to that evidence, if only because it may be a long time before we have an opportunity to reconsider these matters.
Their Lordships reached the right conclusion. The Select Committee—its report has been quoted extensively by hon. Members on both sides—having examined these matters in great detail, was right to make the recommendation that it did. It is a matter for regret that when the Bill was last before the House, we did not have the opportunity to discuss the report. We have the opportunity now to debate and act on it, and we should do so.
The Secretary of State was not right in everything he said at the start of the debate, but as an ex-president of the Convention of Scottish Local Authorities, I readily concede one point—that local authorities have not always been keen or enthusiastic about earmarking funds in this

way. Certainly when I was active in COSLA that was the position. We can understand the reasons for that. I plead with the Secretary of State and the House to consider seriously why local authorities have changed their minds, as they would admit, on such a fundamental issue. It is because they are so worried about the issues they face.
It is not simply a question of arguing for education or transport or whatever to be ring-fenced. Local authorities are dealing with an enormous problem. Principal among the many issues facing them is what is described as the demographic time bomb. Happily, many people are now living to a ripe old age, but that presents great problems for local authorities, for the Government, the House and the Treasury. Community care and social services are distinguished from other functions by the Government's decision, which the Secretary of State warmly endorsed today, that funding from the Department of Social Security should be switched to local government, which should then be responsible for making the resources available to clients. As a principle, that is almost without precedent. The Secretary of State cannot disregard such an important decision and such an important recommendation.
If we consider the way in which the funds have been administered so far, in the absence of earmarking, the House cannot have the confidence to say that all the money will be allocated in the way that we would wish. There is no evidence to believe that.

Mr. Nicholas Winterton: Does not the hon. Gentleman think it extremely strange that the Government are almost on their own in opposing ring fencing and are forcing additional responsibilities on local government without specifying the amount of resources that they are prepared to allocate for those very vulnerable people who cannot represent their own best interests?

Mr. Clarke: The hon. Gentleman is right. I hope that I can say with some humility that I have attended seminars and conferences around the country and I cannot remember any occasion when the majority of those present did not agree with the view that the hon. Gentleman has just expressed.
When local authorities consider their responsibilities, they must distinguish between competing priorities. The House decided that the Children Act 1989 should be written into the statute book. That was a very important measure and it reflected the concern of the House about the grave issue of child abuse. However, in the absence of ring fencing, social service departments may have to choose between allocating money to that purpose or allocating it to the elderly, the disabled, the carers or the mentally handicapped. I do not believe that that decision should be left so vague in the light of our discussions and the advice of people such as Sir Roy Griffiths and the Select Committee.
We have also had debates about environmental health. Local authorities must make a choice and take a decision. The record in identifying where that money is going in social services is quite appalling. Under the Disabled Persons (Services, Consultation and Representation) Act 1986, the Department of Health's inspectorate published a report in January which showed that, in one authority, at


least, some of the resources got lost. Given the limited resources available for those purposes, we do not believe that any money should simply get lost.
Towards the end of this all too brief debate, the House would be extremely foolish to disregard the carefully taken decision of another place. It would be foolish also to disregard the overwhelming view of local authorities and the almost unanimous view of those in social services. We have not got things right so far, and if on this occasion we ignore the advice of another place, I believe that chaos will prevail and we shall have no excuse.

Mrs. Virginia Bottomley: This has been an important and lengthy debate on the crucial question of funding the policies of care in the community. As my right hon. and learned Friend the Secretary of State made only too clear, those policies are popular and important. To implement them, we have been carrying out a major programme with local authorities, voluntary organisations and others who are concerned about care in the community so that we can talk through the practical realities. Although I understand why ring fencing has emerged as a major issue today, I wish that we could have spent a similar amount of time on some of the details of the change in culture, the work that must be undertaken, and the different ways of looking at care in the community. It is not merely a question of ring fencing.
My right hon. and learned Friend put the Government's view on ring fencing at the beginning of this debate. We believe that ring fencing serves to undermine local government accountability. Where large sums of money are involved—we are talking about hundreds of millions of pounds in the transfer of resources from social security to local authority spending—it is both wrong and inappropriate to ring-fence those resources, for the reasons that were so forcefully and clearly expressed by many of my hon. Friends, including my hon. Friends the Members for Mid-Kent (Mr. Rowe), for Fylde (Mr. Jack) and for Hornchurch (Mr. Squire). Many of my hon. Friends spoke ably from positions of authority.
However, we see a need for specific grants in areas where there has been an inadequacy of provision. The mental illness specific grant is a good example. A mere 3 per cent. of local government spending is directed towards mental illness. As my right hon. and learned Friend again made clear, that is an area in which the integration of services from the health authority and the local authority is of fundamental importance. By having that strategic specific grant and ensuring that the health authority must give approval for that grant, we can ensure that good working relationships are properly established. Mental illness spending contrasts with the 8 per cent. spending on mental handicap.
Similarly, we use specific grants for training. We target provision on training for the requirements of the Children Act 1989 and on the establishment of services for AIDS patients, all of which meets with the approval of the House. That is why my right hon. and learned Friend's amendment is so important. Specific grant should be available for those who are drug addicts of alcoholics. That point was made at length in Committee and at other stages of the Bill's passage. We have considered it carefully and have held meetings with many voluntary organisations and others involved.
That is a typical example of the way in which the Government have treated the proposals for care in the

community. We have discussed and scrutinised. Where the force of the argument has made it clear that we should modify our proposals, we have been only too willing to do so. However, I am afraid that we are not convinced by the arguments on overall ring fencing—in spite of the important points made by many distinguished right hon. and hon. Members for whom I have the highest regard on this matter.
My hon. Friend the Member for Ealing, Acton (Sir G. Young) referred to the areas where there are statutory requirements for the local authority to undertake tasks. It was his arguments in Committee, when he made precisely that point, that led us to accept many of the amendments that he sought. Many aspects of care in the community were to be the subject of guidance and were not to be written on the face of the Bill. It was my hon. Friend's concern about complaints, about the requirement to consult housing and health authorities, and his concern that that should be written on the face of the Bill rather than in guidance that won the day and convinced us.
However, the statutory requirements are nowhere near as inconsiderable as he has sought to suggest. Local authorities will be under a duty to prepare and publish plans for community care, and to consult carers' organisations and users—quite apart from the health and housing departments and the voluntary organisations. They are under a duty to assess for community care services; to exercise social services functions in accordance with directives given by the Secretary of State, and they are under the very important duty to establish a complaints procedure, because ensuring proper quality for the individuals who are subject to community care is a fundamental requirement.

Mr. William McKelvey: Why are the Government so determined not to ring-fence, when the money for the disabled given to Gloucester was spent entirely on road improvements? That is why we suspect that councils will not channel the money in the right direction.

Mrs. Virginia Bottomley: If the hon. Gentleman had been present when my right hon. and learned Friend made his speech, he would have the answer to his question. Personal social services departments have increased their spending by 37 per cent. compared with other departments in local government. They have had no difficulty in fighting their corner and that is a strong argument for not promoting ring fencing.
Local authorities are under a statutory duty to provide services for those who need community care. HonMembers have properly raised the need for local authorities to have some sense of anticipation about what the likely sum of the resources will be. As my right hon. and learned Friend said, we are having further discussions with the Department of Social Security about that substantial sum which will go directly to local authorities. We are also having detailed discussions with local authority associations about what they anticipate the likely needs will be arising from the new proposals.
I accept what my hon. Friend the Member for Tiverton (Mr. Maxwell-Hyslop) said about the increasing areas of responsibility for local government, for example, educational provision arising from the Children Act 1989


and provisions relating to legislation on food. As soon as we can, we shall make clear the precise nature of the sums involved.
We have been able to issue our draft guidance for consultation on plans, inspections, case management and the complaints procedure. They are all subject to consultation, and we look to learn from that.
My hon. Friend the Member for Mid-Kent spoke eloquently about the disadvantages of ring fencing and the House should note the important points that he raised. My hon. Friend represents an authority that has a particularly enlightened policy of care in the community. I have met some of the care managers of Kent and I was impressed by the way in which they made difficult decisions about the right way to provide for the frail and vulnerable.
My hon. Friend seeks to provide that some scheme of empowerment is available to the disabled. He will be aware that in Committee I shared the aspirations behind such a measure. I expressed reservations about whether it would be possible to introduce a workable proposal within the time. I visited a scheme in Hampshire to talk to the severely disabled, those with spinal injuries, who were, with a system of empowerment, able to live independent lives and have effective control over their own budgets. However, within the time it has not been possible to introduce a proposal to meet those aims. I urge my hon. Friend to withdraw the amendment and I agree to work with him to see whether it is possible to achieve a workable proposal at a later date.
My hon. Friend the Member for Bolton, North-East (Mr. Thurnham) has particular knowledge and expertise about care in the community. In Bolton, one of the pilot projects that we set up to develop ideas for care in the community reached a successful conclusion. I greatly appreciate my hon. Friend's comments, because addressing the development of a mixed economy of care and the provision of choice and dignity to the individual is important. My hon. Friend is right in saying that voluntary homes provide more cost-effective care than local authority alternatives. Such are the challenges we must face.
The hon. Member for Greenwich (Mrs. Barnes) spoke about the nature of the incentive. She will understand that the current incentive is all towards placing the frail and the vulnerable in institutions. My right hon. Friend the Secretary of State for Social Security then finances the provision of that care, which presents no difficulty to the social services budget.
The challenge of care in the community is to work with the financial incentives to provide day care alternatives to residential care and, above all, to incorporate the needs and the interests of the users and the carers. Never before have proposals been brought forward which so clearly and forcefully recognise their particular needs and interests.

Mrs. Rosie Barnes: Does not the Minister agree that ring fencing will ensure those choices and that redistribution of funds? Most hon. Members would like the choice of residential care or care at home to be available. Such a choice cannot be made for the right reasons unless the money is available, and that involves ring fencing.

12 midnight

Mrs. Bottomley: It is quite clear that ring fencing is not productive to the innovative thought that we want to go into community care. The challenge for local authorities is to respond to the new framework for the next decade and beyond. It is an important opportunity to which we are committed, working with local authorities to ensure that they can undertake those important tasks. We have announced an important specific grant in a category where there has been concern. We have met that concern, but we have always said that adequate resources will be available for local authorities to undertake their important new tasks. I urge my hon. Friends to reject the Lords amendment and to support Government amendment (b).

Mr. Rowe: The Minister has pledged to work with me to find a workable solution to the problem that I posed. I shall hold her to that commitment, and on those terms I beg to ask leave to withdraw my amendment (a) to the Lords amendment.

Amendment to the Lords amendment, by leave, withdrawn.

It being eight hours after the commencement of proceedings on the Order [27 June] relating to the National Health Service and Community Care Bill (Allocation of Time) MR. DEPUTY SPEAKER proceeded, pursuant to the said Order, to put forthwith the Question, That this House doth disagree with the Lords in the said amendment—[Mr. Kenneth Clarke.]

Question put:—

The House divided: Ayes 312, Noes 238.

Division No. 269]
[12.1 am


AYES


Adley, Robert
Brooke, Rt Hon Peter


Aitken, Jonathan
Brown, Michael (Brigg &amp; Cl't's)


Alexander, Richard
Bruce, Ian (Dorset South)


Alison, Rt Hon Michael
Buck, Sir Antony


Allason, Rupert
Burns, Simon


Amess, David
Burt, Alistair


Amos, Alan
Butcher, John


Arbuthnot, James
Butler, Chris


Arnold, Jacques (Gravesham)
Butterfill, John


Arnold, Sir Thomas
Carlisle, John, (Luton N)


Ashby, David
Carlisle, Kenneth (Lincoln)


Atkins, Robert
Carrington, Matthew


Atkinson, David
Carttiss, Michael


Baker, Rt Hon K. (Mole Valley)
Cash, William


Baker, Nicholas (Dorset N)
Chalker, Rt Hon Mrs Lynda


Baldry, Tony
Channon, Rt Hon Paul


Banks, Robert (Harrogate)
Chapman, Sydney


Batiste, Spencer
Chope, Christopher


Bellingham, Henry
Clark, Hon Alan (Plym'th S'n)


Bennett, Nicholas (Pembroke)
Clark, Dr Michael (Rochford)


Benyon, W.
Clarke, Rt Hon K. (Rushcliffe)


Bevan, David Gilroy
Colvin, Michael


Biffen, Rt Hon John
Conway, Derek


Blackburn, Dr John G.
Coombs, Anthony (Wyre F'rest)


Blaker, Rt Hon Sir Peter
Coombs, Simon (Swindon)


Body, Sir Richard
Cope, Rt Hon John


Bonsor, Sir Nicholas
Couchman, James


Boscawen, Hon Robert
Cran, James


Boswell, Tim
Critchley, Julian


Bottomley, Peter
Currie, Mrs Edwina


Bottomley, Mrs Virginia
Davies, Q. (Stamf'd &amp; Spald'g)


Bowden, A (Brighton K'pto'n)
Davis, David (Boothferry)


Bowden, Gerald (Dulwich)
Devlin, Tim


Bowis, John
Dickens, Geoffrey


Boyson, Rt Hon Dr Sir Rhodes
Dicks, Terry


Braine, Rt Hon Sir Bernard
Dorrell, Stephen


Brandon-Bravo, Martin
Douglas-Hamilton, Lord James


Brazier, Julian
Dover, Den


Bright, Graham
Dunn, Bob






Dykes, Hugh
King, Rt Hon Tom (Bridgwater)


Emery, Sir Peter
Kirkhope, Timothy


Evans, David (Welwyn Hatf'd)
Knapman, Roger


Evennett, David
Knight, Greg (Derby North)


Fairbairn, Sir Nicholas
Knowles, Michael


Fallon, Michael
Knox, David


Favell, Tony
Lamont, Rt Hon Norman


Fenner, Dame Peggy
Lang, Ian


Field, Barry (Isle of Wight)
Latham, Michael


Finsberg, Sir Geoffrey
Lawson, Rt Hon Nigel


Fishburn, John Dudley
Lee, John (Pendle)


Forman, Nigel
Leigh, Edward (Gainsbor'gh)


Forsyth, Michael (Stirling)
Lennox-Boyd, Hon Mark


Fowler, Rt Hon Sir Norman
Lester, Jim (Broxtowe)


Fox, Sir Marcus
Lilley, Peter


Franks, Cecil
Lloyd, Sir Ian (Havant)


Freeman, Roger
Lloyd, Peter (Fareham)


French, Douglas
Lord, Michael


Fry, Peter
Luce, Rt Hon Richard


Gale, Roger
Lyell, Rt Hon Sir Nicholas


Gardiner, George
Macfarlane, Sir Neil


Garel-Jones, Tristan
MacGregor, Rt Hon John


Gill, Christopher
MacKay, Andrew (E Berkshire)


Glyn, Dr Sir Alan
Maclean, David


Goodlad, Alastair
McLoughlin, Patrick


Goodson-Wickes, Dr Charles
McNair-Wilson, Sir Michael


Gorman, Mrs Teresa
McNair-Wilson, Sir Patrick


Gorst, John
Madel, David


Gow, Ian
Major, Rt Hon John


Grant, Sir Anthony (CambsSW)
Malins, Humfrey


Greenway, Harry (Ealing N)
Mans, Keith


Greenway, John (Ryedale)
Maples, John


Gregory, Conal
Marland, Paul


Griffiths, Sir Eldon (Bury St E')
Marlow, Tony


Griffiths, Peter (Portsmouth N)
Marshall, John (Hendon S)


Grist, Ian
Marshall, Sir Michael (Arundel)


Ground, Patrick
Martin, David (Portsmouth S)


Grylls, Michael
Maude, Hon Francis


Gummer, Rt Hon John Selwyn
Mayhew, Rt Hon Sir Patrick


Hague, William
Mellor, David


Hamilton, Hon Archie (Epsom)
Miller, Sir Hal


Hamilton, Neil (Tatton)
Mills, Iain


Hampson, Dr Keith
Miscampbell, Norman


Hanley, Jeremy
Mitchell, Andrew (Gedling)


Hargreaves, A. (B'ham H'll Gr')
Mitchell, Sir David


Hargreaves, Ken (Hyndburn)
Moate, Roger


Harris, David
Monro, Sir Hector


Haselhurst, Alan
Montgomery, Sir Fergus


Hayward, Robert
Moore, Rt Hon John


Heathcoat-Amory, David
Morrison, Sir Charles


Heseltine, Rt Hon Michael
Morrison, Rt Hon P (Chester)


Hicks, Mrs Maureen (Wolv NE)
Moss, Malcolm


Hicks, Robert (Cornwall SE)
Moynihan, Hon Colin


Hill, James
Neale, Gerrard


Hind, Kenneth
Needham, Richard


Hogg, Hon Douglas (Gr'th'm)
Nelson, Anthony


Holt, Richard
Neubert, Michael


Hordern, Sir Peter
Newton, Rt Hon Tony


Howard, Rt Hon Michael
Nicholls, Patrick


Howarth, Alan (Strat'd-on-A)
Nicholson, David (Taunton)


Howarth, G. (Cannock &amp; B'wd)
Nicholson, Emma (Devon West)


Howe, Rt Hon Sir Geoffrey
Norris, Steve


Howell, Rt Hon David (G'dford)
Onslow, Rt Hon Cranley


Howell, Ralph (North Norfolk)
Oppenheim, Phillip


Hughes, Robert G. (Harrow W)
Page, Richard


Hunt, David (Wirral W)
Paice, James


Hunt, Sir John (Ravensbourne)
Parkinson, Rt Hon Cecil


Hunter, Andrew
Patnick, Irvine


Hurd, Rt Hon Douglas
Patten, Rt Hon John


Irvine, Michael
Pattie, Rt Hon Sir Geoffrey


Irving, Sir Charles
Pawsey, James


Jack, Michael
Peacock, Mrs Elizabeth


Jackson, Robert
Porter, Barry (Wirral S)


Janman, Tim
Porter, David (Waveney)


Jessel, Toby
Portillo, Michael


Johnson Smith, Sir Geoffrey
Raison, Rt Hon Timothy


Jones, Robert B (Herts W)
Redwood, John


Jopling, Rt Hon Michael
Renton, Rt Hon Tim


Key, Robert
Riddick, Graham


King, Roger (B'ham N'thfield)
Ridley, Rt Hon Nicholas





Ridsdale, Sir Julian
Taylor, Ian (Esher)


Rifkind, Rt Hon Malcolm
Taylor, John M (Solihull)


Roberts, Wyn (Conwy)
Taylor, Teddy (S'end E)


Roe, Mrs Marion
Tebbit, Rt Hon Norman


Rost, Peter
Temple-Morris, Peter


Rowe, Andrew
Thompson, D. (Calder Valley)


Rumbold, Mrs Angela
Thompson, Patrick (Norwich N)


Ryder, Richard
Thornton, Malcolm


Sackville, Hon Tom
Thurnham, Peter


Sainsbury, Hon Tim
Townsend, Cyril D. (B'heath)


Shaw, David (Dover)
Tracey, Richard


Shaw, Sir Giles (Pudsey)
Tredinnick, David


Shaw, Sir Michael (Scarb')
Trippier, David


Shelton, Sir William
Trotter, Neville


Shephard, Mrs G. (Norfolk SW)
Twinn, Dr Ian


Shepherd, Colin (Hereford)
Vaughan, Sir Gerard


Shepherd, Richard (Aldridge)
Viggers, Peter


Shersby, Michael
Waddington, Rt Hon David


Sims, Roger
Wakeham, Rt Hon John


Skeet, Sir Trevor
Waldegrave, Rt Hon William


Smith, Sir Dudley (Warwick)
Walden, George


Smith, Tim (Beaconsfield)
Walker, Bill (T'side North)


Soames, Hon Nicholas
Waller, Gary


Speller, Tony
Ward, John


Spicer, Sir Jim (Dorset W)
Wardle, Charles (Bexhill)


Spicer, Michael (S Worcs)
Warren, Kenneth


Squire, Robin
Wells, Bowen


Stanbrook, Ivor
Wheeler, Sir John


Stanley, Rt Hon Sir John
Whitney, Ray


Steen, Anthony
Widdecombe, Ann


Stern, Michael
Wiggin, Jerry


Stevens, Lewis
Wilshire, David


Stewart, Allan (Eastwood)
Wood, Timothy


Stewart, Andy (Sherwood)
Woodcock, Dr. Mike


Stewart, Rt Hon Ian (Herts N)
Yeo, Tim


Stradling Thomas, Sir John



Sumberg, David
Tellers for the Ayes:


Summerson, Hugo
Mr. Tony Durant and


Tapsell, Sir Peter
Mr. David Lightbown.




NOES


Adams, Allen (Paisley N)
Clay, Bob


Allen, Graham
Clelland, David


Alton, David
Clwyd, Mrs Ann


Anderson, Donald
Cohen, Harry


Archer, Rt Hon Peter
Coleman, Donald


Armstrong, Hilary
Cook, Frank (Stockton N)


Ashdown, Rt Hon Paddy
Cook, Robin (Livingston)


Ashley, Rt Hon Jack
Corbett, Robin


Ashton, Joe
Corbyn, Jeremy


Banks, Tony (Newham NW)
Cousins, Jim


Barnes, Harry (Derbyshire NE)
Cox, Tom


Barnes, Mrs Rosie (Greenwich)
Crowther, Stan


Barron, Kevin
Cryer, Bob


Beckett, Margaret
Cummings, John


Bell, Stuart
Cunliffe, Lawrence


Benn, Rt Hon Tony
Cunningham, Dr John


Bennett, A. F. (D'nt'n &amp; R'dish)
Dalyell, Tam


Bermingham, Gerald
Darling, Alistair


Bidwell, Sydney
Davies, Rt Hon Denzil (Llanelli)


Blair, Tony
Davies, Ron (Caerphilly)


Blunkett, David
Davis, Terry (B'ham Hodge H'I)


Boateng, Paul
Day, Stephen


Boyes, Roland
Dewar, Donald


Bradley, Keith
Dixon, Don


Brown, Gordon (D'mline E)
Dobson, Frank


Brown, Nicholas (Newcastle E)
Doran, Frank


Brown, Ron (Edinburgh Leith)
Duffy, A. E. P.


Bruce, Malcolm (Gordon)
Dunnachie, Jimmy


Buckley, George J.
Dunwoody, Hon Mrs Gwyneth


Caborn, Richard
Eastham, Ken


Callaghan, Jim
Evans, John (St Helens N)


Campbell, Menzies (Fife NE)
Ewing, Harry (Falkirk E)


Campbell, Ron (Blyth Valley)
Ewing, Mrs Margaret (Moray)


Campbell-Savours, D. N.
Fatchett, Derek


Canavan, Dennis
Fearn, Ronald


Carlile, Alex (Mont'g)
Field, Frank (Birkenhead)


Carr, Michael
Fields, Terry (L'pool B G'n)


Clark, Dr David (S Shields)
Fisher, Mark


Clarke, Tom (Monklands W)
Flannery, Martin






Flynn, Paul
Michie, Bill (Sheffield Heeley)


Foot, Rt Hon Michael
Michie, Mrs Ray (Arg'l &amp; Bute)


Foster, Derek
Mitchell, Austin (G't Grimsby)


Foulkes, George
Moonie, Dr Lewis


Fraser, John
Morgan, Rhodri


Fyfe, Maria
Morley, Elliot


Galloway, George
Morris, Rt Hon A. (W'shawe)


Gilbert, Rt Hon Dr John
Morris, Rt Hon J. (Aberavon)


Godman, Dr Norman A.
Morris, M (N'hampton S)


Gould, Bryan
Mowlam, Marjorie


Graham, Thomas
Mullin, Chris


Grant, Bernie (Tottenham)
Murphy, Paul


Griffiths, Nigel (Edinburgh S)
Nellist, Dave


Griffiths, Win (Bridgend)
Oakes, Rt Hon Gordon


Grocott, Bruce
O'Brien, William


Hardy, Peter
O'Neill, Martin


Harman, Ms Harriet
Orme, Rt Hon Stanley


Hattersley, Rt Hon Roy
Parry, Robert


Hayes, Jerry
Patchett, Terry


Heal, Mrs Sylvia
Pendry, Tom


Henderson, Doug
Pike, Peter L.


Hinchliffe, David
Powell, Ray (Ogmore)


Hoey, Ms Kate (Vauxhall)
Prescott, John


Hogg, N. (C'nauld &amp; Kilsyth)
Price, Sir David


Hood, Jimmy
Primarolo, Dawn


Howarth, George (Knowsley N)
Quin, Ms Joyce


Howell, Rt Hon D. (S'heath)
Randall, Stuart


Howells, Geraint
Redmond, Martin


Howells, Dr. Kim (Pontypridd)
Rees, Rt Hon Merlyn


Hoyle, Doug
Reid, Dr John


Hughes, John (Coventry NE)
Richardson, Jo


Hughes, Robert (Aberdeen N)
Robertson, George


Hughes, Roy (Newport E)
Robinson, Geoffrey


Hughes, Simon (Southwark)
Rogers, Allan


Illsley, Eric
Rooker, Jeff


Ingram, Adam
Ross, Ernie (Dundee W)


Janner, Greville
Ross, William (Londonderry E)


Johnston, Sir Russell
Rowlands, Ted


Jones, Barry (Alyn &amp; Deeside)
Ruddock, Joan


Jones, Ieuan (Ynys Môn)
Salmond, Alex


Jones, Martyn (Clwyd S W)
Sheerman, Barry


Kaufman, Rt Hon Gerald
Sheldon, Rt Hon Robert


Kellett-Bowman, Dame Elaine
Shore, Rt Hon Peter


Kennedy, Charles
Short, Clare


Kilfedder, James
Sillars, Jim


Kinnock, Rt Hon Neil
Skinner, Dennis


Kirkwood, Archy
Smith, Andrew (Oxford E)


Lambie, David
Smith, C. (Isl'ton &amp; F'bury)


Lamond, James
Smith, Rt Hon J. (Monk'ds E)


Leadbitter, Ted
Soley, Clive


Leighton, Ron
Spearing, Nigel


Lewis, Terry
Steel, Rt Hon Sir David


Litherland, Robert
Steinberg, Gerry


Livingstone, Ken
Stott, Roger


Livsey, Richard
Strang, Gavin


Lloyd, Tony (Stretford)
Straw, Jack


Lofthouse, Geoffrey
Taylor, Mrs Ann (Dewsbury)


Loyden, Eddie
Taylor, Matthew (Truro)


McAllion, John
Thomas, Dr Dafydd Elis


McAvoy, Thomas
Thompson, Jack (Wansbeck)


McCartney, Ian
Turner, Dennis


Macdonald, Calum A.
Vaz, Keith


McKay, Allen (Barnsley West)
Wallace, James


McKelvey, William
Walley, Joan


McLeish, Henry
Wareing, Robert N.


McNamara, Kevin
Watson, Mike (Glasgow, C)


Madden, Max
Welsh, Andrew (Angus E)


Mahon, Mrs Alice
Welsh, Michael (Doncaster N)


Marek, Dr John
Wigley, Dafydd


Marshall, David (Shettleston)
Williams, Rt Hon Alan


Marshall, Jim (Leicester S)
Williams, Alan W. (Carm'then)


Martin, Michael J. (Springburn)
Wilson, Brian


Martlew, Eric
Winnick, David


Maxton, John
Winterton, Mrs Ann


Maxwell-Hyslop, Robin
Winterton, Nicholas


Meacher, Michael
Wise, Mrs Audrey


Meale, Alan
Wolfson, Mark


Meyer, Sir Anthony
Worthington, Tony


Michael, Alun
Wray, Jimmy





Young, David (Bolton SE)
Tellers for the Noes:


Young, Sir George (Acton)
Mr. Frank Haynes and



Mrs. Llin Golding.

Question accordingly agreed to.

Lords amendment No. 70 disagreed to.

Amendments made to the Bill in lieu thereof: (b), in clause 46, page 53, line 18, after 'incurred', insert (a)'.

(c), in page 53, line 20, at end insert
or
(b) in making payments, in accordance with directions given by the Secretary of State to voluntary organisations which provide care and services for persons who are, have been, or are likely to become dependent upon alcohol or drugs.'.—[Mr. Kenneth Clarke.]

Clause 49

LOCAL AUTHORITY PLANS FOR COMMUNITY CARE SERVICES

Lords amendment: No. 95, in page 54, line 7, at end insert—
(ba) such voluntary organisations as appear to the authority to represent the interests of persons who use or are likely to use any community care services within the area of the authority or the interests of private carers who, within that area, provide a substantial amount of care on a regular basis to persons for whom, in the exercise of their functions under this Act or any of the enactments mentioned in section 2(2) of this Act, the local authority have a power or a duty to provide, or to secure the provision of, a service.

Read a Second time.

Amendment made to the Lords amendment, to leave out
'a substantial amount of care on a regular basis'
and insert care'.—[Mr. Michael Forsyth.]

Lords amendment, as amended, agreed to.

MR. DEPUTY SPEAKER then proceeded to put forthwith the Questions on motions moved by a Minister of the Crown.

Lords amendment: No. 71, before clause 40, to insert the following new clause—

Implementation of Part III Timetable for implementation

.—(1) This Part, other than this section and section 44 below, shall have effect subject to the making of an Order or Orders by the Secretary of State after consultation with such organisations representative of local authorities, users and carers as appear to him to be concerned.

(2) Section 44 below shall have effect from the date of Royal Assent.

(3) No Order shall be made in respect of any other provision of this Part under section 63(2) below except where the Secretary of State is satisfied that the resources available to local authorities are adequate to secure the proper carrying out of their duties in a manner conducive to the interests and welfare of any person for whom community care services may be provided or arranged.

(4) For the purposes of subsection (3) above, no Order shall be made unless the Secretary of State is satisfied that resources sufficient to the requirements of subsection (3) above are available in respect of the implementation by authorities of the functions subject to the Order in the first financial year in which they apply and that such resources are likely to be sufficient in the succeeding four financial years based on his estimate of the likely cost of those functions over those years."

Motion made, and Question proposed, That this House doth disagree with the Lords in the said amendment.—[Mr Kenneth Clarke.]

Question put:—

The House divided: Ayes 317, Noes 225.

Division No. 270]
[12.17 am


AYES


Adley, Robert
Douglas-Hamilton, Lord James


Aitken, Jonathan
Dover, Den


Alexander, Richard
Dunn, Bob


Alison, Rt Hon Michael
Dykes, Hugh


Allason, Rupert
Emery, Sir Peter


Amess, David
Evans, David (Welwyn Hatf'd)


Amos, Alan
Evennett, David


Arbuthnot, James
Fairbairn, Sir Nicholas


Arnold, Jacques (Gravesham)
Fallon, Michael


Arnold, Sir Thomas
Farr, Sir John


Ashby, David
Favell, Tony


Atkins, Robert
Fenner, Dame Peggy


Atkinson, David
Field, Barry (Isle of Wight)


Baker, Rt Hon K. (Mole Valley)
Finsberg, Sir Geoffrey


Baker, Nicholas (Dorset N)
Fishburn, John Dudley


Baldry, Tony
Forman, Nigel


Banks, Robert (Harrogate)
Forsyth, Michael (Stirling)


Batiste, Spencer
Forth, Eric


Bellingham, Henry
Fowler, Rt Hon Sir Norman


Bendall, Vivian
Fox, Sir Marcus


Bennett, Nicholas (Pembroke)
Franks, Cecil


Benyon, W.
Freeman, Roger


Bevan, David Gilroy
French, Douglas


Biffen, Rt Hon John
Gale, Roger


Blackburn, Dr John G.
Gardiner, George


Blaker, Rt Hon Sir Peter
Garel-Jones, Tristan


Body, Sir Richard
Gill, Christopher


Bonsor, Sir Nicholas
Glyn, Dr Sir Alan


Boscawen, Hon Robert
Goodhart, Sir Philip


Boswell, Tim
Goodlad, Alastair


Bottomley, Peter
Goodson-Wickes, Dr Charles


Bottomley, Mrs Virginia
Gorman, Mrs Teresa


Bowden, A (Brighton K'pto'n)
Gorst, John


Bowden, Gerald (Dulwich)
Gow, Ian


Bowis, John
Grant, Sir Anthony (CambsSW)


Boyson, Rt Hon Dr Sir Rhodes
Greenway, Harry (Ealing N)


Braine, Rt Hon Sir Bernard
Greenway, John (Ryedale)


Brandon-Bravo, Martin
Gregory, Conal


Brazier, Julian
Griffiths, Sir Eldon (Bury St E')


Bright, Graham
Griffiths, Peter (Portsmouth N)


Brooke, Rt Hon Peter
Grist, Ian


Brown, Michael (Brigg &amp; CI't's)
Ground, Patrick


Bruce, Ian (Dorset South)
Grylls, Michael


Buck, Sir Antony
Gummer, Rt Hon John Selwyn


Burns, Simon
Hague, William


Burt, Alistair
Hamilton, Hon Archie (Epsom)


Butcher, John
Hamilton, Neil (Tatton)


Butler, Chris
Hampson, Dr Keith


Butterfill, John
Hanley, Jeremy


Carlisle, John. (Luton N)
Hannam, John


Carlisle, Kenneth (Lincoln)
Hargreaves, A. (B'ham H'll Gr')


Carrington, Matthew
Hargreaves, Ken (Hyndburn)


Carttiss, Michael
Harris, David


Cash, William
Haselhurst, Alan


Chalker, Rt Hon Mrs Lynda
Hayes, Jerry


Channon, Rt Hon Paul
Hayward, Robert


Chapman, Sydney
Heathcoat-Amory, David


Chope, Christopher
Heseltine, Rt Hon Michael


Clark, Hon Alan (Plym'th S'n)
Hicks, Mrs Maureen (Wolv NE)


Clark, Dr Michael (Rochford)
Hicks, Robert (Cornwall SE)


Clarke, Rt Hon K. (Rushcliffe)
Hill, James


Colvin, Michael
Hind, Kenneth


Conway, Derek
Hogg, Hon Douglas (Gr'th'm)


Coombs, Anthony (Wyre F'rest)
Hordern, Sir Peter


Coombs, Simon (Swindon)
Howard, Rt Hon Michael


Cope, Rt Hon John
Howarth, Alan (Strat'd-on-A)


Couchman, James
Howarth, G. (Cannock &amp; B'wd)


Cran, James
Howe, Rt Hon Sir Geoffrey


Critchley, Julian
Howell, Rt Hon David (G'dford)


Currie, Mrs Edwina
Hughes, Robert G. (Harrow W)


Davies, Q. (Stamf'd &amp; Spald'g)
Hunt, David (Wirral W)


Davis, David (Boothferry)
Hunt, Sir John (Ravensbourne)


Day, Stephen
Hunter, Andrew


Devlin, Tim
Hurd, Rt Hon Douglas


Dickens, Geoffrey
Irvine, Michael


Dicks, Terry
Irving, Sir Charles


Dorrell, Stephen
Jack, Michael





Jackson, Robert
Peacock, Mrs Elizabeth


Janman, Tim
Porter, Barry (Wirral S)


Jessel, Toby
Porter, David (Waveney)


Johnson Smith, Sir Geoffrey
Portillo, Michael


Jones, Robert B (Herts W)
Price, Sir David


Jopling, Rt Hon Michael
Raison, Rt Hon Timothy


Kellett-Bowman, Dame Elaine
Rathbone, Tim


Key, Robert
Redwood, John


King, Roger (B'ham N'thfield)
Renton, Rt Hon Tim


King, Rt Hon Tom (Bridgwater)
Riddick, Graham


Kirkhope, Timothy
Ridley, Rt Hon Nicholas


Knapman, Roger
Ridsdale, Sir Julian


Knight, Greg (Derby North)
Rifkind, Rt Hon Malcolm


Knowles, Michael
Roberts, Wyn (Conwy)


Knox, David
Roe, Mrs Marion


Lang, Ian
Rumbold, Mrs Angela


Latham, Michael
Ryder, Richard


Lawson, Rt Hon Nigel
Sackville, Hon Tom


Lee, John (Pendle)
Sainsbury, Hon Tim


Leigh, Edward (Gainsbor'gh)
Shaw, David (Dover)


Lennox-Boyd, Hon Mark
Shaw, Sir Giles (Pudsey)


Lester, Jim (Broxtowe)
Shaw, Sir Michael (Scarb')


Lilley, Peter
Shelton, Sir William


Lloyd, Sir Ian (Havant)
Shephard, Mrs G. (Norfolk SW)


Lloyd, Peter (Fareham)
Shepherd, Colin (Hereford)


Lord, Michael
Shepherd, Richard (Aldridge)


Luce, Rt Hon Richard
Shersby, Michael


Lyell, Rt Hon Sir Nicholas
Sims, Roger


Macfarlane, Sir Neil
Skeet, Sir Trevor


MacGregor, Rt Hon John
Smith, Sir Dudley (Warwick)


MacKay, Andrew (E Berkshire)
Smith, Tim (Beaconsfield)


Maclean, David
Soames, Hon Nicholas


McLoughlin, Patrick
Speller, Tony


McNair-Wilson, Sir Michael
Spicer, Sir Jim (Dorset W)


McNair-Wilson, Sir Patrick
Spicer, Michael (S Worcs)


Madel, David
Squire, Robin


Major, Rt Hon John
Stanbrook, Ivor


Malins, Humfrey
Stanley, Rt Hon Sir John


Mans, Keith
Steen, Anthony


Maples, John
Stern, Michael


Marland, Paul
Stevens, Lewis


Marlow, Tony
Stewart, Allan (Eastwood)


Marshall, John (Hendon S)
Stewart, Andy (Sherwood)


Marshall, Sir Michael (Arundel)
Stewart, Rt Hon Ian (Herts N)


Martin, David (Portsmouth S)
Sumberg, David


Maude, Hon Francis
Summerson, Hugo


Maxwell-Hyslop, Robin
Tapsell, Sir Peter


Mayhew, Rt Hon Sir Patrick
Taylor, Ian (Esher)


Mellor, David
Taylor, John M (Solihull)


Meyer, Sir Anthony
Taylor, Teddy (S'end E)


Miller, Sir Hal
Tebbit, Rt Hon Norman


Mills, Iain
Temple-Morris, Peter


Miscampbell, Norman
Thompson, D. (Calder Valley)


Mitchell, Andrew (Gedling)
Thompson, Patrick (Norwich N)


Mitchell, Sir David
Thornton, Malcolm


Moate, Roger
Thurnham, Peter


Monro, Sir Hector
Townsend, Cyril D. (B'heath)


Montgomery, Sir Fergus
Tracey, Richard


Morrison, Sir Charles
Trippier, David


Morrison, Rt Hon P (Chester)
Trotter, Neville


Moss, Malcolm
Twinn, Dr Ian


Moynihan, Hon Colin
Vaughan, Sir Gerard


Neale, Gerrard
Viggers, Peter


Needham, Richard
Wakeham, Rt Hon John


Nelson, Anthony
Waldegrave, Rt Hon William


Neubert, Michael
Walden, George


Newton, Rt Hon Tony
Walker, Bill (T'side North)


Nicholls, Patrick
Waller, Gary


Nicholson, David (Taunton)
Ward, John


Nicholson, Emma (Devon West)
Wardle, Charles (Bexhill)


Norris, Steve
Warren, Kenneth


Onslow, Rt Hon Cranley
Wells, Bowen


Oppenheim, Phillip
Wheeler, Sir John


Page, Richard
Whitney, Ray


Paice, James
Widdecombe, Ann


Parkinson, Rt Hon Cecil
Wiggin, Jerry


Patnick, Irvine
Wilshire, David


Patten, Rt Hon John
Winterton, Mrs Ann


Pattie, Rt Hon Sir Geoffrey
Wolfson, Mark


Pawsey, James
Wood, Timothy






Woodcock, Dr. Mike
Tellers for the Ayes:


Yeo, Tim
Mr. Tony Durant and


Young, Sir George (Acton)
Mr. David Lightbown.




NOES


Adams, Allen (Paisley N)
Field, Frank (Birkenhead)


Allen, Graham
Fields, Terry (L'pool B G'n)


Alton, David
Fisher, Mark


Anderson, Donald
Flannery, Martin


Archer, Rt Hon Peter
Flynn, Paul


Armstrong, Hilary
Foot, Rt Hon Michael


Ashdown, Rt Hon Paddy
Foster, Derek


Ashley, Rt Hon Jack
Foulkes, George


Ashton, Joe
Fraser, John


Banks, Tony (Newham NW)
Fyfe, Maria


Barnes, Harry (Derbyshire NE)
Galloway, George


Barnes, Mrs Rosie (Greenwich)
Gilbert, Rt Hon Dr John


Barron, Kevin
Godman, Dr Norman A.


Beckett, Margaret
Golding, Mrs Llin


Bell, Stuart
Gould, Bryan


Benn, Rt Hon Tony
Graham, Thomas


Bennett, A. F. (D'nt'n &amp; R'dish)
Grant, Bernie (Tottenham)


Bermingham, Gerald
Griffiths, Nigel (Edinburgh S)


Bidwell, Sydney
Griffiths, Win (Bridgend)


Blair, Tony
Grocott, Bruce


Blunkett, David
Hardy, Peter


Boateng, Paul
Harman, Ms Harriet


Boyes, Roland
Hattersley, Rt Hon Roy


Bradley, Keith
Heal, Mrs Sylvia


Brooke, Rt Hon Peter
Henderson, Doug


Brown, Gordon (D'mline E)
Hinchliffe, David


Brown, Nicholas (Newcastle E)
Hoey, Ms Kate (Vauxhall)


Brown, Ron (Edinburgh Leith)
Hogg, N. (C'nauld &amp; Kilsyth)


Bruce, Malcolm (Gordon)
Hood, Jimmy


Buckley, George J.
Howarth, George (Knowsley N)


Caborn, Richard
Howells, Geraint


Callaghan, Jim
Howells, Dr. Kim (Pontypridd)


Campbell, Menzies (Fife NE)
Hoyle, Doug


Campbell, Ron (Blyth Valley)
Hughes, John (Coventry NE)


Campbell-Savours, D. N.
Hughes, Robert (Aberdeen N)


Canavan, Dennis
Hughes, Roy (Newport E)


Carlile, Alex (Mont'g)
Hughes, Simon (Southwark)


Carr, Michael
Illsley, Eric


Clark, Dr David (S Shields)
Ingram, Adam


Clarke, Tom (Monklands W)
Janner, Greville


Clay, Bob
Johnston, Sir Russell


Clelland, David
Jones, Barry (Alyn &amp; Deeside)


Clwyd, Mrs Ann
Jones, Ieuan (Ynys Môon)


Cohen, Harry
Jones, Martyn (Clwyd S W)


Coleman, Donald
Kaufman, Rt Hon Gerald


Cook, Frank (Stockton N)
Kennedy, Charles


Cook, Robin (Livingston)
Kilfedder, James


Corbett, Robin
Kinnock, Rt Hon Neil


Corbyn, Jeremy
Kirkwood, Archy


Cousins, Jim
Lambie, David


Cox, Tom
Lamond, James


Crowther, Stan
Leadbitter, Ted


Cryer, Bob
Leighton, Ron


Cummings, John
Lewis, Terry


Cunliffe, Lawrence
Litherland, Robert


Cunningham, Dr John
Livingstone, Ken


Dalyell, Tam
Livsey, Richard


Darling, Alistair
Lloyd, Tony (Stretford)


Davies, Rt Hon Denzil (Llanelli)
Lofthouse, Geoffrey


Davies, Ron (Caerphilly)
Loyden, Eddie


Davis, Terry (B'ham Hodge H'I)
McAllion, John


Dewar, Donald
McAvoy, Thomas


Dixon, Don
McCartney, Ian


Dobson, Frank
Macdonald, Calum A.


Doran, Frank
McKay, Allen (Barnsley West)


Duffy, A. E. P.
McKelvey, William


Dunnachie, Jimmy
McLeish, Henry


Dunwoody, Hon Mrs Gwyneth
McNamara, Kevin


Eastham, Ken
Madden, Max


Evans, John (St Helens N)
Mahon, Mrs Alice


Ewing, Harry (Falkirk E)
Marek, Dr John


Ewing, Mrs Margaret (Moray)
Marshall, David (Shettleston)


Fatchett, Derek
Marshall, Jim (Leicester S)


Fearn, Ronald
Martin, Michael J. (Springburn)





Martlew, Eric
Ruddock, Joan


Maxton, John
Salmond, Alex


Meacher, Michael
Sheerman, Barry


Meale, Alan
Sheldon, Rt Hon Robert


Michael, Alun
Shore, Rt Hon Peter


Michie, Bill (Sheffield Heeley)
Short, Clare


Michie, Mrs Ray (Arg'l &amp; Bute)
Skinner, Dennis


Mitchell, Austin (G't Grimsby)
Smith, Andrew (Oxford E)


Moonie, Dr Lewis
Smith, C. (Isl'ton &amp; F'bury)


Morgan, Rhodri
Smith, Rt Hon J. (Monk'ds E)


Morley, Elliot
Soley, Clive


Morris, Rt Hon A. (W'shawe)
Spearing, Nigel


Morris, Rt Hon J. (Aberavon)
Steel, Rt Hon Sir David


Morris, M (N'hampton S)
Steinberg, Gerry


Mowlam, Marjorie
Stott, Roger


Mullin, Chris
Strang, Gavin


Murphy, Paul
Straw, Jack


Nellist, Dave
Taylor, Mrs Ann (Dewsbury)


Oakes, Rt Hon Gordon
Taylor, Matthew (Truro)


O'Brien, William
Thomas, Dr Dafydd Elis


O'Neill, Martin
Thompson, Jack (Wansbeck)


Orme, Rt Hon Stanley
Turner, Dennis


Parry, Robert
Vaz, Keith


Patchett, Terry
Wallace, James


Pendry, Tom
Walley, Joan


Pike, Peter L.
Watson, Mike (Glasgow, C)


Powell, Ray (Ogmore)
Welsh, Andrew (Angus E)


Prescott, John
Welsh, Michael (Doncaster N)


Primarolo, Dawn
Wigley, Dafydd


Quin, Ms Joyce
Williams, Rt Hon Alan


Randall, Stuart
Williams, Alan W. (Carm'then)


Redmond, Martin
Wilson, Brian


Rees, Rt Hon Merlyn
Winnick, David


Reid, Dr John
Wise, Mrs Audrey


Richardson, Jo
Worthington, Tony


Robertson, George
Wray, Jimmy


Robinson, Geoffrey
Young, David (Bolton SE)


Rogers, Allan



Rooker, Jeff
Tellers for the Noes:


Ross, Ernie (Dundee W)
Mr. Frank Haynes and


Rowlands, Ted
Mr. Robert N. Wareing.

Question accordingly agreed to.

Lords amendment: No. 72, before clause 40 to insert the following new clause—

Start-up costs

.—(1) The Secretary of State may, for up to five years from the date of any Order under this section, in relation to the functions covered by that Order and with the approval of the Treasury make grants out of money provided by Parliament towards any expenses incurred by local authorities in connection with the establishing of functions and activities arising under this Part, and in making any determination as to the adequacy or otherwise of resources under subsection (4) above the Secretary of State shall have regard to the desirability of making grants under this subsection.

(2) A grant made under subsection (5) above may be for capital or revenue expenditure."

Motion made, and Question proposed, That this House doth disagree with the Lords in the said amendment—[Mr. Kenneth Clarke.]

Question put:—

The House divided: Ayes 310, Noes 219.

Division No. 271]
[12.30 am


AYES


Adley, Robert
Atkinson, David


Aitken, Jonathan
Baker, Rt Hon K. (Mole Valley)


Alexander, Richard
Baker, Nicholas (Dorset N)


Alison, Rt Hon Michael
Baldry, Tony


Allason, Rupert
Banks, Robert (Harrogate)


Amess, David
Batiste, Spencer


Amos, Alan
Bellingham, Henry


Arbuthnot, James
Bendall, Vivian


Arnold, Jacques (Gravesham)
Bennett, Nicholas (Pembroke)


Arnold, Sir Thomas
Benyon, W.


Ashby, David
Bevan, David Gilroy


Atkins, Robert
Biffen, Rt Hon John






Blackburn, Dr John G.
Goodlad, Alastair


Blaker, Rt Hon Sir Peter
Goodson-Wickes, Dr Charles


Body, Sir Richard
Gorman, Mrs Teresa


Bonsor, Sir Nicholas
Gorst, John


Boscawen, Hon Robert
Gow, Ian


Boswell, Tim
Grant, Sir Anthony (CambsSW)


Bottomley, Peter
Greenway, Harry (Ealing N)


Bottomley, Mrs Virginia
Greenway, John (Ryedale)


Bowden, A (Brighton K'pto'n)
Gregory, Conal


Bowden, Gerald (Dulwich)
Griffiths, Sir Eldon (Bury St E')


Bowis, John
Griffiths, Peter (Portsmouth N)


Boyson, Rt Hon Dr Sir Rhodes
Grist, Ian


Braine, Rt Hon Sir Bernard
Ground, Patrick


Brandon-Bravo, Martin
Grylls, Michael


Brazier, Julian
Gummer, Rt Hon John Selwyn


Bright, Graham
Hague, William


Brooke, Rt Hon Peter
Hamilton, Hon Archie (Epsom)


Brown, Michael (Brigg &amp; CI't's)
Hamilton, Neil (Tatton)


Bruce, Ian (Dorset South)
Hampson, Dr Keith


Buck, Sir Antony
Hanley, Jeremy


Burns, Simon
Hannam, John


Burt, Alistair
Hargreaves, A. (B'ham H'll Gr')


Butler, Chris
Hargreaves, Ken (Hyndburn)


Butterfill, John
Harris, David


Carlisle, John, (Luton N)
Haselhurst, Alan


Carlisle, Kenneth (Lincoln)
Hayes, Jerry


Carrington, Matthew
Hayward, Robert


Carttiss, Michael
Heathcoat-Amory, David


Cash, William
Hicks, Mrs Maureen (Wolv' NE)


Chalker, Rt Hon Mrs Lynda
Hicks, Robert (Cornwall SE)


Channon, Rt Hon Paul
Hill, James


Chapman, Sydney
Hind, Kenneth


Chope, Christopher
Hogg, Hon Douglas (Gr'th'm)


Clark, Dr Michael (Rochford)
Hordern, Sir Peter


Clarke, Rt Hon K. (Rushcliffe)
Howard, Rt Hon Michael


Colvin, Michael
Howarth, Alan (Strat'd-on-A)


Conway, Derek
Howarth, G. (Cannock &amp; B'wd)


Coombs, Anthony (Wyre F'rest)
Howe, Rt Hon Sir Geoffrey


Coombs, Simon (Swindon)
Howell, Rt Hon David (G'dford)


Cope, Rt Hon John
Hughes, Robert G. (Harrow W)


Couchman, James
Hunt, David (Wirral W)


Cran, James
Hunt, Sir John (Ravensbourne)


Critchley, Julian
Hunter, Andrew


Currie, Mrs Edwina
Irvine, Michael


Davies, Q. (Stamf'd &amp; Spald'g)
Jack, Michael


Davis, David (Boothferry)
Jackson, Robert


Day, Stephen
Janman, Tim


Devlin, Tim
Jessel, Toby


Dickens, Geoffrey
Johnson Smith, Sir Geoffrey


Dicks, Terry
Jones, Robert B (Herts W)


Dorrell, Stephen
Jopling, Rt Hon Michael


Douglas-Hamilton, Lord James
Kellett-Bowman, Dame Elaine


Dover, Den
Key, Robert


Dunn, Bob
King, Roger (B'ham N'thfield)


Durant, Tony
King, Rt Hon Tom (Bridgwater)


Emery, Sir Peter
Kirkhope, Timothy


Evans, David (Welwyn Hatf'd)
Knapman, Roger


Evennett, David
Knight, Greg (Derby North)


Fairbairn, Sir Nicholas
Knowles, Michael


Fallon, Michael
Knox, David


Farr, Sir John
Lang, Ian


Favell, Tony
Latham, Michael


Fenner, Dame Peggy
Lee, John (Pendle)


Field, Barry (Isle of Wight)
Leigh, Edward (Galnsbor'gh)


Fishburn, John Dudley
Lennox-Boyd, Hon Mark


Forman, Nigel
Lester, Jim (Broxtowe)


Forsyth, Michael (Stirling)
Lilley, Peter


Forth, Eric
Lloyd, Sir Ian (Havant)


Fowler, Rt Hon Sir Norman
Lloyd, Peter (Fareham)


Fox, Sir Marcus
Lord, Michael


Franks, Cecil
Luce, Rt Hon Richard


Freeman, Roger
Lyell, Rt Hon Sir Nicholas


French, Douglas
Macfarlane, Sir Neil


Fry, Peter
MacGregor, Rt Hon John


Gale, Roger
MacKay, Andrew (E Berkshire)


Gardiner, George
Maclean, David


Garel-Jones, Tristan
McLoughlin, Patrick


Gill, Christopher
McNair-Wilson, Sir Michael


Glyn, Dr Sir Alan
McNair-Wilson, Sir Patrick


Goodhart, Sir Philip
Madel, David





Malins, Humfrey
Shelton, Sir William


Mans, Keith
Shephard, Mrs G. (Norfolk SW)


Maples, John
Shepherd, Colin (Hereford)


Marland, Paul
Shepherd, Richard (Aldridge)


Marlow, Tony
Shersby, Michael


Marshall, John (Hendon S)
Sims, Roger


Marshall, Sir Michael (Arundel)
Skeet, Sir Trevor


Martin, David (Portsmouth S)
Smith, Sir Dudley (Warwick)


Maude, Hon Francis
Smith, Tim (Beaconsfield)


Maxwell-Hyslop, Robin
Soames, Hon Nicholas


Mayhew, Rt Hon Sir Patrick
Speller, Tony


Mellor, David
Spicer, Sir Jim (Dorset W)


Meyer, Sir Anthony
Spicer, Michael (S Worcs)


Miller, Sir Hal
Squire, Robin


Mills, Iain
Stanbrook, Ivor


Miscampbell, Norman
Stanley, Rt Hon Sir John


Mitchell, Andrew (Gedling)
Steen, Anthony


Mitchell, Sir David
Stern, Michael


Moate, Roger
Stevens, Lewis


Monro, Sir Hector
Stewart, Allan (Eastwood)


Montgomery, Sir Fergus
Stewart, Andy (Sherwood)


Morrison, Sir Charles
Stewart, Rt Hon Ian (Herts N)


Morrison, Rt Hon P (Chester)
Stradling Thomas, Sir John


Moss, Malcolm
Sumberg, David


Moynihan, Hon Colin
Summerson, Hugo


Neale, Gerrard
Tapsell, Sir Peter


Needham, Richard
Taylor, Ian (Esher)


Nelson, Anthony
Taylor, John M (Solihull)


Neubert, Michael
Taylor, Teddy (S'end E)


Newton, Rt Hon Tony
Temple-Morris, Peter


Nicholls, Patrick
Thompson, D. (Calder Valley)


Nicholson, David (Taunton)
Thompson, Patrick (Norwich N)


Nicholson, Emma (Devon West)
Thornton, Malcolm


Norris, Steve
Thurnham, Peter


Onslow, Rt Hon Cranley
Townsend, Cyril D. (B'heath)


Oppenheim, Phillip
Tracey, Richard


Page, Richard
Tredinnick, David


Paice, James
Trippier, David


Parkinson, Rt Hon Cecil
Trotter, Neville


Patnick, Irvine
Twinn, Dr Ian


Patten, Rt Hon John
Vaughan, Sir Gerard


Pattie, Rt Hon Sir Geoffrey
Viggers, Peter


Pawsey, James
Wakeham, Rt Hon John


Peacock, Mrs Elizabeth
Waldegrave, Rt Hon William


Porter, Barry (Wirral S)
Walden, George


Porter, David (Waveney)
Walker, Bill (T'side North)


Portillo, Michael
Waller, Gary


Price, Sir David
Ward, John


Raison, Rt Hon Timothy
Wardle, Charles (Bexhill)


Rathbone, Tim
Warren, Kenneth


Redwood, John
Wells, Bowen


Renton, Rt Hon Tim
Wheeler, Sir John


Riddick, Graham
Whitney, Ray


Ridsdale, Sir Julian
Widdecombe, Ann


Rifkind, Rt Hon Malcolm
Wiggin, Jerry


Roberts, Wyn (Conwy)
Wilshire, David


Roe, Mrs Marion
Winterton, Mrs Ann


Rumbold, Mrs Angela
Wolfson, Mark


Ryder, Richard
Woodcock, Dr. Mike


Sackville, Hon Tom
Yeo, Tim


Sainsbury, Hon Tim
Young, Sir George (Acton)


Scott, Rt Hon Nicholas



Shaw, David (Dover)
Tellers for the Ayes:


Shaw, Sir Giles (Pudsey)
Mr. David Lightbown and


Shaw, Sir Michael (Scarb')
Mr. Timothy Wood.




NOES


Adams, Allen (Paisley N)
Beckett, Margaret


Allen, Graham
Bell, Stuart


Alton, David
Benn, Rt Hon Tony


Anderson, Donald
Bennett, A. F. (D'nt'n &amp; R'dish)


Archer, Rt Hon Peter
Bermingham, Gerald


Armstrong, Hilary
Bidwell, Sydney


Ashdown, Rt Hon Paddy
Blair, Tony


Ashley, Rt Hon Jack
Blunkett, David


Ashton, Joe
Boateng, Paul


Banks, Tony (Newham NW)
Boyes, Roland


Barnes, Harry (Derbyshire NE)
Bradley, Keith


Barnes, Mrs Rosie (Greenwich)
Brown, Gordon (D'mline E)


Barron, Kevin
Brown, Nicholas (Newcastle E)






Brown, Ron (Edinburgh Leith)
Ingram, Adam


Bruce, Malcolm (Gordon)
Janner, Greville


Buckley, George J.
Johnston, Sir Russell


Caborn, Richard
Jones, Barry (Alyn &amp; Deeside)


Callaghan, Jim
Jones, Ieuan (Ynys Môn)


Campbell, Menzies (Fife NE)
Jones, Martyn (Clwyd S W)


Campbell, Ron (Blyth Valley)
Kaufman, Rt Hon Gerald


Campbell-Savours, D. N.
Kennedy, Charles


Canavan, Dennis
Kilfedder, James


Carlile, Alex (Mont'g)
Kirkwood, Archy


Carr, Michael
Lambie, David


Clark, Dr David (S Shields)
Lamond, James


Clarke, Tom (Monklands W)
Leadbitter, Ted


Clelland, David
Leighton, Ron


Clwyd, Mrs Ann
Lewis, Terry


Cohen, Harry
Litherland, Robert


Coleman, Donald
Livingstone, Ken


Cook, Frank (Stockton N)
Livsey, Richard


Cook, Robin (Livingston)
Lloyd, Tony (Stretford)


Corbett, Robin
Lofthouse, Geoffrey


Corbyn, Jeremy
Loyden, Eddie


Cox, Tom
McAllion, John


Crowther, Stan
McAvoy, Thomas


Cryer, Bob
McCartney, Ian


Cummings, John
Macdonald, Calum A.


Cunliffe, Lawrence
McKay, Allen (Barnsley West)


Cunningham, Dr John
McKelvey, William


Dalyell, Tam
McLeish, Henry


Darling, Alistair
McNamara, Kevin


Davies, Rt Hon Denzil (Llanelli)
Madden, Max


Davies, Ron (Caerphilly)
Mahon, Mrs Alice


Davis, Terry (B'ham Hodge H'I)
Marek, Dr John


Dewar, Donald
Marshall, David (Shettleston)


Dixon, Don
Marshall, Jim (Leicester S)


Dobson, Frank
Martin, Michael J. (Springburn)


Doran, Frank
Martlew, Eric


Duffy, A. E. P.
Maxton, John


Dunnachie, Jimmy
Meacher, Michael


Dunwoody, Hon Mrs Gwyneth
Meale, Alan


Eastham, Ken
Michael, Alun


Evans, John (St Helens N)
Michie, Bill (Sheffield Heeley)


Ewing, Harry (Falkirk E)
Michie, Mrs Ray (Arg'l &amp; Bute)


Ewing, Mrs Margaret (Moray)
Mitchell, Austin (G't Grimsby)


Fatchett, Derek
Moonie, Dr Lewis


Fearn, Ronald
Morgan, Rhodri


Field, Frank (Birkenhead)
Morley, Elliot


Fields, Terry (L'pool B G'n)
Morris, Rt Hon A. (W'shawe)


Fisher, Mark
Morris, Rt Hon J. (Aberavon)


Flannery, Martin
Mowlam, Marjorie


Flynn, Paul
Mullin, Chris


Foot, Rt Hon Michael
Murphy, Paul


Foster, Derek
Nellist, Dave


Foulkes, George
O'Brien, William


Fraser, John
O'Neill, Martin


Fyfe, Maria
Orme, Rt Hon Stanley


Galloway, George
Parry, Robert


Gilbert, Rt Hon Dr John
Patchett, Terry


Godman, Dr Norman A.
Pendry, Tom


Gould, Bryan
Pike, Peter L.


Graham, Thomas
Powell, Ray (Ogmore)


Grant, Bernie (Tottenham)
Prescott, John


Griffiths, Nigel (Edinburgh S)
Primarolo, Dawn


Griffiths, Win (Bridgend)
Quin, Ms Joyce


Grocott, Bruce
Randall, Stuart


Hardy, Peter
Redmond, Martin


Harman, Ms Harriet
Rees, Rt Hon Merlyn


Hattersley, Rt Hon Roy
Reid, Dr John


Heal, Mrs Sylvia
Richardson, Jo


Hinchliffe, David
Robertson, George


Hoey, Ms Kate (Vauxhall)
Robinson, Geoffrey


Hogg, N. (C'nauld &amp; Kilsyth)
Rogers, Allan


Hood, Jimmy
Rooker, Jeff


Howells, Geraint
Ross, Ernie (Dundee W)


Howells, Dr. Kim (Pontypridd)
Ross, William (Londonderry E)


Hoyle, Doug
Rowlands, Ted


Hughes, John (Coventry NE)
Ruddock, Joan


Hughes, Robert (Aberdeen N)
Salmond, Alex


Hughes, Roy (Newport E)
Sheerman, Barry


Hughes, Simon (Southwark)
Sheldon, Rt Hon Robert


Illsley, Eric
Shore, Rt Hon Peter





Short, Clare
Walley, Joan


Skinner, Dennis
Wareing, Robert N.


Smith, Andrew (Oxford E)
Watson, Mike (Glasgow, C)


Smith, C. (Isl'ton &amp; F'bury)
Welsh, Andrew (Angus E)


Smith, Rt Hon J. (Monk'ds E)
Welsh, Michael (Doncaster N)


Soley, Clive
Wigley, Dafydd


Spearing, Nigel
Williams, Rt Hon Alan


Steel, Rt Hon Sir David
Williams, Alan W. (Carm'then)


Steinberg, Gerry
Wilson, Brian


Stott, Roger
Winnick, David


Strang, Gavin
Wise, Mrs Audrey


Straw, Jack
Worthington, Tony


Taylor, Mrs Ann (Dewsbury)
Wray, Jimmy


Taylor, Matthew (Truro)
Young, David (Bolton SE)


Thomas, Dr Dafydd Elis



Thompson, Jack (Wansbeck)
Tellers for the Noes:


Turner, Dennis
Mr. Frank Haynes and


Vaz, Keith
Mrs. Llin Golding.


Wallace, James

Question accordingly agreed to.

Clause 40

PROVISION OF ACCOMMODATION AND WELFARE SERVICES: AGENCY ARRANGEMENTS

Lords amendment: No. 76, in page 46, line 48, at end insert—
(1D) Before arrangements are made by virtue of this section with any person, that person shall disclose to the local authority making the arrangements any relevant criminal convictions.
(1E) On request by a local authority, a police officer shall disclose to the authority any relevant criminal convictions of any person with whom it is proposed to make arrangements by virtue of this section.
(1F) Relevant criminal convictions for the purposes of subsections (1D) and (1E) above shall be specified in regulations made by the Secretary of State.
(1G) Any person in respect of whom a disclosure is made under subsection (1E) above shall be informed of the disclosure.

Motion made and Question proposed, That this House doth disagree with the Lords in the said amendment. —[Mr. Kenneth Clarke.]

Question put:—

The House divided: Ayes 303, Noes 217.

Division No. 272]
[12.42 am


AYES


Adley, Robert
Bonsor, Sir Nicholas


Aitken, Jonathan
Boscawen, Hon Robert


Alexander, Richard
Boswell, Tim


Alison, Rt Hon Michael
Bottomley, Peter


Allason, Rupert
Bottomley, Mrs Virginia


Amess, David
Bowden, A (Brighton K'pto'n)


Amos, Alan
Bowden, Gerald (Dulwich)


Arbuthnot, James
Bowis, John


Arnold, Jacques (Gravesham)
Boyson, Rt Hon Dr Sir Rhodes


Arnold, Sir Thomas
Brandon-Bravo, Martin


Ashby, David
Brazier, Julian


Atkins, Robert
Bright, Graham


Atkinson, David
Brooke, Rt Hon Peter


Baker, Rt Hon K. (Mole Valley)
Brown, Michael (Brigg &amp; Cl't's)


Baker, Nicholas (Dorset N)
Bruce, Ian (Dorset South)


Baldry, Tony
Buckley, George J.


Banks, Robert (Harrogate)
Burns, Simon


Batiste, Spencer
Burt, Alistair


Bellingham, Henry
Butler, Chris


Bendall, Vivian
Butterfill, John


Bennett, Nicholas (Pembroke)
Carlisle, John, (Luton N)


Benyon, W.
Carlisle, Kenneth (Lincoln)


Bevan, David Gilroy
Carrington, Matthew


Biffen, Rt Hon John
Carttiss, Michael


Blackburn, Dr John G.
Cash, William


Blaker, Rt Hon Sir Peter
Chalker, Rt Hon Mrs Lynda


Body, Sir Richard
Channon, Rt Hon Paul






Chapman, Sydney
Hind, Kenneth


Chope, Christopher
Hogg, Hon Douglas (Gr'th'm)


Clark, Dr Michael (Rochford)
Hordern, Sir Peter


Clarke, Rt Hon K. (Rushcliffe)
Howard, Rt Hon Michael


Colvin, Michael
Howarth, Alan (Strat'd-on-A)


Conway, Derek
Howarth, G. (Cannock &amp; B'wd)


Coombs, Anthony (Wyre F'rest)
Howe, Rt Hon Sir Geoffrey


Coombs, Simon (Swindon)
Howell, Rt Hon David (G'dford)


Cope, Rt Hon John
Hughes, Robert G. (Harrow W)


Couchman, James
Hunt, David (Wirral W)


Cran, James
Hunt, Sir John (Ravensbourne)


Critchley, Julian
Hunter, Andrew


Currie, Mrs Edwina
Irvine, Michael


Davies, Q. (Stamf'd &amp; Spald'g)
Jack, Michael


Davis, David (Boothferry)
Jackson, Robert


Day, Stephen
Janman, Tim


Devlin, Tim
Jessel, Toby


Dicks, Terry
Johnson Smith, Sir Geoffrey


Dorrell, Stephen
Jones, Robert B (Herts W)


Douglas-Hamilton, Lord James
Jopling, Rt Hon Michael


Dover, Den
Kellett-Bowman, Dame Elaine


Dunn, Bob
Key, Robert


Durant, Tony
King, Roger (B'ham N'thfield)


Dykes, Hugh
King, Rt Hon Tom (Bridgwater)


Emery, Sir Peter
Kirkhope, Timothy


Evans, David (Wolwyn Hatf'd)
Knapman, Roger


Evennett, David
Knight, Greg (Derby North)


Fairbairn, Sir Nicholas
Knowles, Michael


Fallon, Michael
Knox, David


Farr, Sir John
Lang, Ian


Favell, Tony
Latham, Michael


Fenner, Dame Peggy
Lee, John (Pendle)


Field, Barry (Isle of Wight)
Leigh, Edward (Galnsbor'gh)


Fishburn, John Dudley
Lennox-Boyd, Hon Mark


Forman, Nigel
Lester, Jim (Broxtowe)


Forsyth, Michael (Stirling)
Lightbown, David


Forth, Eric
Lilley, Peter


Fowler, Rt Hon Sir Norman
Lloyd, Sir Ian (Havant)


Fox, Sir Marcus
Lloyd, Peter (Fareham)


Franks, Cecil
Lord, Michael


Freeman, Roger
Luce, Rt Hon Richard


French, Douglas
Macfarlane, Sir Neil


Fry, Peter
MacKay, Andrew (E Berkshire)


Gale, Roger
Maclean, David


Gardiner, George
McLoughlin, Patrick


Garel-Jones, Tristan
McNair-Wilson, Sir Michael


Gill, Christopher
McNair-Wilson, Sir Patrick


Glyn, Dr Sir Alan
Madel, David


Goodhart, Sir Philip
Malins, Humfrey


Goodlad, Alastair
Mans, Keith


Goodson-Wickes, Dr Charles
Maples, John


Gorman, Mrs Teresa
Marland, Paul


Gorst, John
Marlow, Tony


Gow, Ian
Marshall, John (Hendon S)


Grant, Sir Anthony (CambsSW)
Marshall, Sir Michael (Arundel)


Greenway, Harry (Ealing N)
Martin, David (Portsmouth S)


Greenway, John (Ryedale)
Maude, Hon Francis


Gregory, Conal
Maxwell-Hyslop, Robin


Griffiths, Sir Eldon (Bury St E')
Mayhew, Rt Hon Sir Patrick


Griffiths, Peter (Portsmouth N)
Mellor, David


Grist, Ian
Meyer, Sir Anthony


Ground, Patrick
Miller, Sir Hal


Grylls, Michael
Mills, Iain


Gummer, Rt Hon John Selwyn
Miscampbell, Norman


Hague, William
Mitchell, Andrew (Gedling)


Hamilton, Hon Archie (Epsom)
Mitchell, Sir David


Hamilton, Neil (Tatton)
Moate, Roger


Hampson, Dr Keith
Monro, Sir Hector


Hanley, Jeremy
Montgomery, Sir Fergus


Hannam, John
Morrison, Sir Charles


Hargreaves, A. (B'ham H'll Gr')
Morrison, Rt Hon P (Chester)


Hargreaves, Ken (Hyndburn)
Moss, Malcolm


Harris, David
Moynihan, Hon Colin


Haselhurst, Alan
Neale, Gerrard


Hayes, Jerry
Needham, Richard


Hayward, Robert
Nelson, Anthony


Heathcoat-Amory, David
Neubert, Michael


Hicks, Mrs Maureen (Wolv' NE)
Newton, Rt Hon Tony


Hicks, Robert (Cornwall SE)
Nicholls, Patrick


Hill, James
Nicholson, David (Taunton)





Nicholson, Emma (Devon West)
Steen, Anthony


Norris, Steve
Stern, Michael


Onslow, Rt Hon Cranley
Stewart, Allan (Eastwood)


Oppenheim, Phillip
Stewart, Andy (Sherwood)


Page, Richard
Stewart, Rt Hon Ian (Herts N)


Paice, James
Stradling Thomas, Sir John


Parkinson, Rt Hon Cecil
Sumberg, David


Patten, Rt Hon John
Summerson, Hugo


Pattie, Rt Hon Sir Geoffrey
Tapsell, Sir Peter


Pawsey, James
Taylor, Ian (Esher)


Peacock, Mrs Elizabeth
Taylor, John M (Solihull)


Porter, Barry (Wirral S)
Taylor, Teddy (S'end E)


Porter, David (Waveney)
Temple-Morris, Peter


Portillo, Michael
Thompson, D. (Calder Valley)


Price, Sir David
Thompson, Patrick (Norwich N)


Raison, Rt Hon Timothy
Thornton, Malcolm


Rathbone, Tim
Thurnham, Peter


Redwood, John
Townsend, Cyril D. (B'heath)


Renton, Rt Hon Tim
Tracey, Richard


Riddick, Graham
Tredinnick, David


Rifkind, Rt Hon Malcolm
Trippier, David


Roberts, Sir Wyn (Conwy)
Twinn, Dr Ian


Roe, Mrs Marion
Vaughan, Sir Gerard


Rumbold, Mrs Angela
Viggers, Peter


Ryder, Richard
Waldegrave, Rt Hon William


Sackville, Hon Tom
Walden, George


Sainsbury, Hon Tim
Walker, Bill (T'side North)


Scott, Rt Hon Nicholas
Waller, Gary


Shaw, David (Dover)
Ward, John


Shaw, Sir Giles (Pudsey)
Wardle, Charles (Bexhill)


Shaw, Sir Michael (Scarb')
Warren, Kenneth


Shelton, Sir William
Wells, Bowen


Shephard, Mrs G. (Norfolk SW)
Wheeler, Sir John


Shepherd, Colin (Hereford)
Whitney, Ray


Shepherd, Richard (Aldridge)
Widdecombe, Ann


Shersby, Michael
Wiggin, Jerry


Sims, Roger
Wilshire, David


Skeet, Sir Trevor
Winterton, Mrs Ann


Smith, Sir Dudley (Warwick)
Wolfson, Mark


Smith, Tim (Beaconsfield)
Woodcock, Dr. Mike


Soames, Hon Nicholas
Yeo, Tim


Speller, Tony
Young, Sir George (Acton)


Spicer, Sir Jim (Dorset W)



Spicer, Michael (S Worcs)
Tellers for the Ayes:


Squire, Robin
Mr. Timothy Wood and


Stanbrook, Ivor
Mr. Irvine Patrick.


Stanley, Rt Hon Sir John





NOES


Adams, Allen (Paisley N)
Campbell, Ron (Blyth Valley)


Allen, Graham
Campbell-Savours, D. N.


Alton, David
Canavan, Dennis


Anderson, Donald
Carlile, Alex (Mont'g)


Archer, Rt Hon Peter
Carr, Michael


Armstrong, Hilary
Clark, Dr David (S Shields)


Ashley, Rt Hon Jack
Clarke, Tom (Monklands W)


Ashton, Joe
Clelland, David


Banks, Tony (Newham NW)
Clwyd, Mrs Ann


Barnes, Harry (Derbyshire NE)
Cohen, Harry


Barnes, Mrs Rosie (Greenwich)
Coleman, Donald


Barron, Kevin
Cook, Frank (Stockton N)


Beckett, Margaret
Cook, Robin (Livingston)


Bell, Stuart
Corbett, Robin


Benn, Rt Hon Tony
Corbyn, Jeremy


Bennett, A. F. (D'nt'n &amp; R'dish)
Cox, Tom


Bermingham, Gerald
Crowther, Stan


Bidwell, Sydney
Cryer, Bob


Blair, Tony
Cummings, John


Blunkett, David
Cunliffe, Lawrence


Boateng, Paul
Cunningham, Dr John


Boyes, Roland
Dalyell, Tam


Bradley, Keith
Darling, Alistair


Brown, Gordon (D'mline E)
Davies, Rt Hon Denzil (Llanelli)


Brown, Nicholas (Newcastle E)
Davies, Ron (Caerphilly)


Brown, Ron (Edinburgh Leith)
Davis, Terry (B'ham Hodge H'I)


Bruce, Malcolm (Gordon)
Dewar, Donald


Buckley, George J.
Dixon, Don


Caborn, Richard
Dobson, Frank


Callaghan, Jim
Doran, Frank


Campbell, Menzies (Fife NE)
Duffy, A. E. P.






Dunnachie, Jimmy
Meacher, Michael


Dunwoody, Hon Mrs Gwyneth
Meale, Alan


Eastham, Ken
Michael, Alun


Evans, John (St Helens N)
Michie, Bill (Sheffield Heeley)


Ewing, Harry (Falkirk E)
Michie, Mrs Ray (Arg'l &amp; Bute)


Ewing, Mrs Margaret (Moray)
Mitchell, Austin (G't Grimsby)


Fatchett, Derek
Moonie, Dr Lewis


Fearn, Ronald
Morgan, Rhodri


Field, Frank (Birkenhead)
Morley, Elliot


Fields, Terry (L'pool B G'n)
Morris, Rt Hon A. (W'shawe)


Fisher, Mark
Morris, Rt Hon J. (Aberavon)


Flannery, Martin
Mowlam, Marjorie


Flynn, Paul
Mullin, Chris


Foot, Rt Hon Michael
Murphy, Paul


Foster, Derek
Nellist, Dave


Foulkes, George
Oakes, Rt Hon Gordon


Fraser, John
O'Brien, William


Fyfe, Maria
O'Neill, Martin


Galloway, George
Orme, Rt Hon Stanley


Gilbert, Rt Hon Dr John
Parry, Robert


Godman, Dr Norman A.
Patchett, Terry


Gould, Bryan
Pendry, Tom


Graham, Thomas
Pike, Peter L.


Grant, Bernie (Tottenham)
Powell, Ray (Ogmore)


Griffiths, Nigel (Edinburgh S)
Prescott, John


Griffiths, Win (Bridgend)
Primarolo, Dawn


Grocott, Bruce
Quin, Ms Joyce


Hardy, Peter
Randall, Stuart


Harman, Ms Harriet
Redmond, Martin


Hattersley, Rt Hon Roy
Rees, Rt Hon Merlyn


Haynes, Frank
Reid, Dr John


Heal, Mrs Sylvia
Richardson, Jo


Hinchliffe, David
Robertson, George


Hoey, Ms Kate (Vauxhall)
Robinson, Geoffrey


Hogg, N. (C'nauld &amp; Kilsyth)
Rogers, Allan


Hood, Jimmy
Rooker, Jeff


Howells, Geraint
Ross, Ernie (Dundee W)


Howells, Dr. Kim (Pontypridd)
Rowlands, Ted


Hoyle, Doug
Ruddock, Joan


Hughes, John (Coventry NE)
Salmond, Alex


Hughes, Robert (Aberdeen N)
Sheerman, Barry


Hughes, Roy (Newport E)
Sheldon, Rt Hon Robert


Hughes, Simon (Southwark)
Shore, Rt Hon Peter


Illsley, Eric
Short, Clare


Ingram, Adam
Skinner, Dennis


Janner, Greville
Smith, Andrew (Oxford E)


Johnston, Sir Russell
Smith, C. (Isl'ton &amp; F'bury)


Jones, Barry (Alyn &amp; Deeside)
Smith, Rt Hon J. (Monk'ds E)


Jones, Ieuan (Ynys Môn)
Soley, Clive


Jones, Martyn (Clwyd S W)
Spearing, Nigel


Kaufman, Rt Hon Gerald
Steel, Rt Hon Sir David


Kennedy, Charles
Steinberg, Gerry


Kilfedder, James
Stott, Roger


Kirkwood, Archy
Strang, Gavin


Lambie, David
Straw, Jack


Lamond, James
Taylor, Mrs Ann (Dewsbury)


Leadbitter, Ted
Taylor, Matthew (Truro)


Leighton, Ron
Thomas, Dr Dafydd Elis


Lewis, Terry
Thompson, Jack (Wansbeck)


Litherland, Robert
Turner, Dennis


Livingstone, Ken
Vaz, Keith


Livsey, Richard
Wallace, James


Lofthouse, Geoffrey
Walley, Joan


Loyden, Eddie
Watson, Mike (Glasgow, C)


McAllion, John
Welsh, Andrew (Angus E)


McAvoy, Thomas
Welsh, Michael (Doncaster N)


McCartney, Ian
Wigley, Dafydd


Macdonald, Calum A.
Williams, Rt Hon Alan


McKay, Allen (Barnsley West)
Williams, Alan W. (Carm'then)


McKelvey, William
Wilson, Brian


McLeish, Henry
Winnick, David


McNamara, Kevin
Wise, Mrs Audrey


Madden, Max
Worthington, Tony


Mahon, Mrs Alice
Wray, Jimmy


Marek, Dr John
Young, David (Bolton SE)


Marshall, David (Shettleston)



Marshall, Jim (Leicester S)
Tellers for the Noes:


Martin, Michael J. (Springburn)
Mi. Robert N. Wareing and


Martlew, Eric
Mrs. Llin Golding.


Maxton, John

Question accordingly agreed to.

Clause 44

LOCAL AUTHORITY PLANS FOR COMMUNITY CARE SERVICES.

Lords amendment: No. 81, in page 50, line 12, at end insert—
( ) The plan for the provision of community care services referred to in subsection (1) above shall, in the case of those local authorities which are housing authorities, include details on how those authorities propose to meet the housing needs of the persons in their areas who are in need of community care services.

Motion made, and Question proposed, That this House doth disagree with the Lords in the said amendment:—[Mr. Kenneth Clarke.]

Question put:—

The House divided: Ayes 300, Noes 213.

Division No. 273]
[12.54 am


AYES


Adley, Robert
Clark, Dr Michael (Rochford)


Aitken, Jonathan
Clarke, Rt Hon K. (Rushcliffe)


Alexander, Richard
Colvin, Michael


Alison, Rt Hon Michael
Conway, Derek


Allason, Rupert
Coombs, Anthony (Wyre F'rest)


Amess, David
Coombs, Simon (Swindon)


Amos, Alan
Cope, Rt Hon John


Arbuthnot, James
Couchman, James


Arnold, Jacques (Gravesham)
Cran, James


Arnold, Sir Thomas
Critchley, Julian


Ashby, David
Currie, Mrs Edwina


Atkins, Robert
Davies, Q. (Stamf'd &amp; Spald'g)


Atkinson, David
Davis, David (Boothferry)


Baker, Rt Hon K. (Mole Valley)
Day, Stephen


Baker, Nicholas (Dorset N)
Devlin, Tim


Baldry, Tony
Dicks, Terry


Banks, Robert (Harrogate)
Dorrell, Stephen


Batiste, Spencer
Douglas-Hamilton, Lord James


Bellingham, Henry
Dover, Den


Bendall, Vivian
Dunn, Bob


Bennett, Nicholas (Pembroke)
Durant, Tony


Benyon, W.
Dykes, Hugh


Bevan, David Gilroy
Emery, Sir Peter


Biffen, Rt Hon John
Evans, David (Welwyn Hatf'd)


Blackburn, Dr John G.
Evennett, David


Blaker, Rt Hon Sir Peter
Fallon, Michael


Body, Sir Richard
Farr, Sir John


Bonsor, Sir Nicholas
Favell, Tony


Boscawen, Hon Robert
Fenner, Dame Peggy


Boswell, Tim
Field, Barry (Isle of Wight)


Bottomley, Peter
Fishburn, John Dudley


Bottomley, Mrs Virginia
Forman, Nigel


Bowden, A (Brighton K'pto'n)
Forsyth, Michael (Stirling)


Bowden, Gerald (Dulwich)
Forth, Eric


Bowis, John
Fowler, Rt Hon Sir Norman


Boyson, Rt Hon Dr Sir Rhodes
Fox, Sir Marcus


Brandon-Bravo, Martin
Franks, Cecil


Brazier, Julian
Freeman, Roger


Bright, Graham
French, Douglas


Brooke, Rt Hon Peter
Fry, Peter


Brown, Michael (Brigg &amp; Cl't's)
Gale, Roger


Bruce, Ian (Dorset South)
Gardiner, George


Burns, Simon
Garel-Jones, Tristan


Burt, Alistair
Gill, Christopher


Butler, Chris
Glyn, Dr Sir Alan


Butterfill, John
Goodhart, Sir Philip


Carlisle, John, (Luton N)
Goodlad, Alastair


Carlisle, Kenneth (Lincoln)
Goodson-Wickes, Dr Charles


Carrington, Matthew
Gorman, Mrs Teresa


Carttiss, Michael
Gorst, John


Cash, William
Gow, Ian


Chalker, Rt Hon Mrs Lynda
Grant, Sir Anthony (CambsSW)


Channon, Rt Hon Paul
Greenway, Harry (Ealing N)


Chapman, Sydney
Greenway, John (Ryedale)


Chope, Christopher
Gregory, Conal






Griffiths, Sir Eldon (Bury St E')
Mellor, David


Griffiths, Peter (Portsmouth N)
Meyer, Sir Anthony


Grist, Ian
Miller, Sir Hal


Ground, Patrick
Mills, Iain


Grylls, Michael
Miscampbell, Norman


Gummer, Rt Hon John Selwyn
Mitchell, Andrew (Gedling)


Hague, William
Mitchell, Sir David


Hamilton, Hon Archie (Epsom)
Moate, Roger


Hamilton, Neil (Tatton)
Monro, Sir Hector


Hampson, Dr Keith
Montgomery, Sir Fergus


Hanley, Jeremy
Morrison, Sir Charles


Hargreaves, A. (B'ham H'll Gr')
Morrison, Rt Hon P (Chester)


Hargreaves, Ken (Hyndburn)
Moss, Malcolm


Harris, David
Moynihan, Hon Colin


Haselhurst, Alan
Neale, Gerrard


Hayes, Jerry
Needham, Richard


Hayward, Robert
Nelson, Anthony


Heathcoat-Amory, David
Neubert, Michael


Hicks, Mrs Maureen (Wolv' NE)
Newton, Rt Hon Tony


Hicks, Robert (Cornwall SE)
Nicholls, Patrick


Hill, James
Nicholson, David (Taunton)


Hind, Kenneth
Nicholson, Emma (Devon West)


Hogg, Hon Douglas (Gr'th'm)
Norris, Steve


Hordern, Sir Peter
Onslow, Rt Hon Cranley


Howard, Rt Hon Michael
Oppenheim, Phillip


Howarth, Alan (Strat'd-on-A)
Page, Richard


Howarth, G. (Cannock &amp; B'wd)
Paice, James


Howe, Rt Hon Sir Geoffrey
Parkinson, Rt Hon Cecil


Howell, Rt Hon David (G'dford)
Patten, Rt Hon John


Hughes, Robert G. (Harrow W)
Pattie, Rt Hon Sir Geoffrey


Hunt, David (Wirral W)
Pawsey, James


Hunt, Sir John (Ravensbourne)
Peacock, Mrs Elizabeth


Hunter, Andrew
Porter, Barry (Wirral S)


Irvine, Michael
Porter, David (Waveney)


Jack, Michael
Portillo, Michael


Jackson, Robert
Price, Sir David


Janman, Tim
Raison, Rt Hon Timothy


Jessel, Toby
Redwood, John


Johnson Smith, Sir Geoffrey
Renton, Rt Hon Tim


Jones, Robert B (Herts W)
Riddick, Graham


Jopling, Rt Hon Michael
Rifkind, Rt Hon Malcolm


Key, Robert
Roberts, Wyn (Conwy)


King, Roger (B'ham N'thfield)
Roe, Mrs Marion


King, Rt Hon Tom (Bridgwater)
Rumbold, Mrs Angela


Kirkhope, Timothy
Ryder, Richard


Knapman, Roger
Sackville, Hon Tom


Knight, Greg (Derby North)
Sainsbury, Hon Tim


Knowles, Michael
Scott, Rt Hon Nicholas


Knox, David
Shaw, David (Dover)


Lang, Ian
Shaw, Sir Giles (Pudsey)


Latham, Michael
Shaw, Sir Michael (Scarb')


Lee, John (Pendle)
Shelton, Sir William


Leigh, Edward (Gainsbor'gh)
Shephard, Mrs G. (Norfolk SW)


Lennox-Boyd, Hon Mark
Shepherd, Colin (Hereford)


Lester, Jim (Broxtowe)
Shepherd, Richard (Aldridge)


Lightbown, David
Shersby, Michael


Lilley, Peter
Sims, Roger


Lloyd, Sir Ian (Havant)
Skeet, Sir Trevor


Lloyd, Peter (Fareham)
Smith, Sir Dudley (Warwick)


Lord, Michael
Smith, Tim (Beaconsfield)


Luce, Rt Hon Richard
Soames, Hon Nicholas


Lyell, Rt Hon Sir Nicholas
Speller, Tony


Macfarlane, Sir Neil
Spicer, Sir Jim (Dorset W)


MacKay, Andrew (E Berkshire)
Spicer, Michael (S Worcs)


Maclean, David
Squire, Robin


McLoughlin, Patrick
Stanbrook, Ivor


McNair-Wilson, Sir Michael
Stanley, Rt Hon Sir John


McNair-Wilson, Sir Patrick
Steen, Anthony


Madel, David
Stern, Michael


Malins, Humfrey
Stevens, Lewis


Mans, Keith
Stewart, Allan (Eastwood)


Maples, John
Stewart, Andy (Sherwood)


Marland, Paul
Stewart, Rt Hon Ian (Herts N)


Marlow, Tony
Stradling Thomas, Sir John


Marshall, John (Hendon S)
Sumberg, David


Marshall, Sir Michael (Arundel)
Summerson, Hugo


Martin, David (Portsmouth S)
Tapsell, Sir Peter


Maude, Hon Francis
Taylor, Ian (Esher)


Maxwell-Hyslop, Robin
Taylor, John M (Solihull)


Mayhew, Rt Hon Sir Patrick
Taylor, Teddy (S'end E)





Temple-Morris, Peter
Wardle, Charles (Bexhill)


Thompson, D. (Calder Valley)
Warren, Kenneth


Thompson, Patrick (Norwich N)
Wells, Bowen


Thornton, Malcolm
Wheeler, Sir John


Thurnham, Peter
Whitney, Ray


Townsend, Cyril D. (B'heath)
Widdecombe, Ann


Tracey, Richard
Wiggin, Jerry


Tredinnick, David
Wilshire, David


Trippier, David
Winterton, Mrs Ann


Twinn, Dr Ian
Wolfson, Mark


Vaughan, Sir Gerard
Woodcock, Dr. Mike


Viggers, Peter
Yeo, Tim


Waldegrave, Rt Hon William
Young, Sir George (Acton)


Walden, George



Walker, Bill (T'side North)
Tellers for the Ayes:


Waller, Gary
Mr. Irvine Patnick and


Ward, John
Mr. Timothy Wood.




NOES


Allen, Graham
Dunwoody, Hon Mrs Gwyneth


Alton, David
Eastham, Ken


Anderson, Donald
Evans, John (St Helens N)


Archer, Rt Hon Peter
Ewing, Harry (Falkirk E)


Armstrong, Hilary
Ewing, Mrs Margaret (Moray)


Ashley, Rt Hon Jack
Fatchett, Derek


Ashton, Joe
Field, Frank (Birkenhead)


Banks, Tony (Newham NW)
Fields, Terry (L'pool B G'n)


Barnes, Harry (Derbyshire NE)
Fisher, Mark


Barnes, Mrs Rosie (Greenwich)
Flannery, Martin


Barron, Kevin
Flynn, Paul


Beckett, Margaret
Foot, Rt Hon Michael


Bell, Stuart
Foster, Derek


Benn, Rt Hon Tony
Foulkes, George


Bennett, A. F. (D'nt'n &amp; R'dish)
Fraser, John


Bermingham, Gerald
Fyfe, Maria


Bidwell, Sydney
Galloway, George


Blair, Tony
Gilbert, Rt Hon Dr John


Blunkett, David
Godman, Dr Norman A.


Boateng, Paul
Golding, Mrs Llin


Boyes, Roland
Gould, Bryan


Bradley, Keith
Graham, Thomas


Brown, Gordon (D'mline E)
Grant, Bernie (Tottenham)


Brown, Nicholas (Newcastle E)
Griffiths, Nigel (Edinburgh S)


Brown, Ron (Edinburgh Leith)
Griffiths, Win (Bridgend)


Bruce, Malcolm (Gordon)
Grocott, Bruce


Buckley, George J.
Hardy, Peter


Caborn, Richard
Harman, Ms Harriet


Callaghan, Jim
Hattersley, Rt Hon Roy


Campbell, Menzies (Fife NE)
Haynes, Frank


Campbell, Ron (Blyth Valley)
Heal, Mrs Sylvia


Campbell-Savours, D. N.
Hinchliffe, David


Canavan, Dennis
Hoey, Ms Kate (Vauxhall)


Carlile, Alex (Mont'g)
Hogg, N. (C'nauld &amp; Kilsyth)


Carr, Michael
Hood, Jimmy


Clark, Dr David (S Shields)
Howells, Geraint


Clarke, Tom (Monklands W)
Howells, Dr. Kim (Pontypridd)


Clelland, David
Hoyle, Doug


Clwyd, Mrs Ann
Hughes, John (Coventry NE)


Cohen, Harry
Hughes, Robert (Aberdeen N)


Coleman, Donald
Hughes, Roy (Newport E)


Cook, Frank (Stockton N)
Hughes, Simon (Southwark)


Cook, Robin (Livingston)
Illsley, Eric


Corbett, Robin
Ingram, Adam


Corbyn, Jeremy
Janner, Greville


Cox, Tom
Johnston, Sir Russell


Crowther, Stan
Jones, Barry (Alyn &amp; Deeside)


Cryer, Bob
Jones, Ieuan (Ynys Môn)


Cummings, John
Jones, Martyn (Clwyd S W)


Cunliffe, Lawrence
Kaufman, Rt Hon Gerald


Cunningham, Dr John
Kennedy, Charles


Dalyell, Tam
Kilfedder, James


Darling, Alistair
Kirkwood, Archy


Davies, Rt Hon Denzil (Llanelli)
Lambie, David


Davis, Terry (B'ham Hodge H'I)
Lamond, James


Dewar, Donald
Leadbitter, Ted


Dixon, Don
Leighton, Ron


Dobson, Frank
Lewis, Terry


Doran, Frank
Litherland, Robert


Duffy, A. E. P.
Livingstone, Ken


Dunnachie, Jimmy
Livsey, Richard






Lloyd, Tony (Stretford)
Randall, Stuart


Lofthouse, Geoffrey
Redmond, Martin


Loyden, Eddie
Rees, Rt Hon Merlyn


McAllion, John
Reid, Dr John


McAvoy, Thomas
Richardson, Jo


McCartney, Ian
Robertson, George


Macdonald, Calum A.
Robinson, Geoffrey


McKay, Allen (Barnsley West)
Rogers, Allan


McKelvey, William
Rooker, Jeff


McLeish, Henry
Ross, Ernie (Dundee W)


McNamara, Kevin
Rowlands, Ted


Madden, Max
Ruddock, Joan


Mahon, Mrs Alice
Sheerman, Barry


Marek, Dr John
Sheldon, Rt Hon Robert


Marshall, David (Shettleston)
Shore, Rt Hon Peter


Marshall, Jim (Leicester S)
Short, Clare


Martin, Michael J. (Springburn)
Skinner, Dennis


Martlew, Eric
Smith. Andrew (Oxford E)


Maxton, John
Smith, C. (Isl'ton &amp; F'bury)


Meacher, Michael
Smith, Rt Hon J. (Monk'ds E)


Meale, Alan
Soley, Clive


Michael, Alun
Spearing, Nigel


Michie, Bill (Sheffield Heeley)
Steel, Rt Hon Sir David


Michie, Mrs Ray (Arg'l &amp; Bute)
Steinberg, Gerry


Mitchell, Austin (G't Grimsby)
Stott, Roger


Moonie, Dr Lewis
Strang, Gavin


Morgan, Rhodri
Straw, Jack


Morley, Elliot
Taylor, Mrs Ann (Dewsbury)


Morris, Rt Hon A. (W'shawe)
Taylor, Matthew (Truro)


Morris, Rt Hon J. (Aberavon)
Thomas, Dr Dafydd Elis


Mowlam, Marjorie
Thompson, Jack (Wansbeck)


Mullin, Chris
Turner, Dennis


Murphy, Paul
Vaz, Keith


Nellist, Dave
Wallace, James


O'Brien, William
Walley, Joan


O'Neill, Martin
Watson, Mike (Glasgow, C)


Parry, Robert
Welsh, Andrew (Angus E)


Patchett, Terry
Welsh, Michael (Doncaster N)


Pendry, Tom
Wigley, Dafydd


Pike, Peter L.
Williams, Rt Hon Alan


Powell, Ray (Ogmore)
Williams, Alan W. (Carm'then)


Prescott, John
Wilson, Brian


Primarolo, Dawn
Winnick, David


Quin, Ms Joyce
Wise, Mrs Audrey





Worthington, Tony
Tellers for the Noes:


Wray, Jimmy
Mr. Allen Adams and


Young, David (Bolton SE)
Mr. Robert N. Wareing.

MR. DEPUTY SPEAKER then proceeded to put forthwith the Question, That this House doth agree with the Lords in the Lords amendments designated by him which had not been disposed of.

Question accordingly agreed to.

Lords amendments Nos. 104, 107, 108, 116, 135, 138 and 163 agreed to [Special Entry.]

MR. DEPUTY SPEAKER then proceeded to put forthwith the Question, That this House doth agree with the Lords in all the remaining Lords amendments.

Lords amendments Nos. 73 to 75, 77 to 80, 82 to 94, 96 to 103, 105, 106, 109 to 115, 117 to 134, 136, 137, 139 to 162 and 164 to 182 agreed to.

Ordered,
That a Committee be appointed to draw up reasons to be assigned to the Lords for disagreeing to their amendments Nos. 71, 72, 76 and 81.—[Mr. Kenneth Clarke.]

Ordered,
That Mrs. Virginia Bottomley, Mr. Kenneth Clarke, Mr. Robin Cook, Mr. Greg Knight and Mr. Allen McKay be members of the Committee.—[Mr. Kenneth Clarke.]

Ordered,
That three be the quorum of the Committee.—[Mr. Kenneth Clarke.]

Ordered, That the Committee do withdraw immediately.—[Mr. Kenneth Clarke.]

AGRICULTURE

Ordered,
That the provisions of paragraph (2) of Standing Order No. 84 (Constitution of standing committees), paragraph (1) of Standing Order No. 86 (Nomination of standing committees) and Standing Order No. 101 (Standing Committees on Statutory Instruments, &amp;c.) shall apply to the draft Code of Recommendations for the Welfare of Livestock—Sheep as if it was a statutory instrument; and that the said draft Code be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. Lightbown.]

Vaccine-damaged Children

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]

Mr. Alistair Burt: I thank the House for the opportunity to raise on the Adjournment the important subject of compensation for vaccine-damaged children.
I first became introduced to my constituent, Bernice, through her parents writing to me. Bernice was born in March 1973. She was vaccinated against whooping cough in June and August of that year and suffered convulsions and brain damage as a consequence. Her chance of a normal life was lost.
In 1978, the Royal Commission on civil liability and compensation for personal injury reported. It included a special passage on vaccine damage, such was the public interest at that time. In essence, it reported that all immunisation carried risk and that there was particular concern about the case of whooping cough vaccine. It considered the absence of a compensation system in this country and compared us to others. It declared its general view:
We do not think it is right to try to distinguish one severely disabled child from another, and to produce a situation where two children have the same needs, but one is compensated and the other is not. We decided, therefore, that vaccine damaged children should be considered with other severely disabled children, irrespective of the cause of disablement.
In its conclusion, the report recommended in relation to vaccine-damaged children:
We recommend that the Government or the local authority concerned should be strictly liable in tort for severe damage suffered by anyone (adult or child) as a result of vaccination which has been recommended in the interests of the community.
Following that report, the Vaccine Damage Payments Act 1979 was passed. According to the Department of Health, the Act provides for
A single lump-sum payment to be made in those cases where the Secretary of State is satisfied that, on the balance of probabilities, severe mental and/or physical disablement was caused by vaccination against any of the diseases certified in the Act.
Payment is made for severe disablement only. This is defined as
Loss of faculty to the extent of eighty per cent. or more assessed as for the Industrial Injuries Disablement Benefit Scheme. Eighty per cent. is customarily recognised as the lower end of the spectrum of severe disablement. The amount of payment under the Vaccine Damage Payments Act was originally set at £10,000. It was subsequently increased to £20,000 for successful claims made after 18 June 1985".
Bernice's parents were successful in a claim in 1982 and were awarded £10,000 for her. Her parents wrote to me saying that the decision of the tribunal was that Bernice
is disabled as a result of vaccination to which the claim relates…The extent of the disability arising from vaccination to which the claim relates amounts to severe disablement".
Bernice is now 17. She cannot dress, feed herself or go to the toilet. She has fits every day. Her walking is severely limited. She is hemiplegic, with lack of movement down the right side. Naturally, communication with her devoted family is desperately limited.
In urging me to take up the matter, Bernice's parents wrote:
Over the years Bernice's condition has not improved, but we know that given the proper training, physiotherapy and speech therapy, she could have been a more independent person than she is today.
That is the personal, moving background behind a statistic.
Since the introduction of the Act, after an initial surge, the number of awards has gradually fallen. In 1979, 349 awards were made. By 1986, the figure was 15, by 1987 it was nine, by 1988 it was three, and by 1989 it was nil. In total, 849 awards have been made, but more than 2,500 have been rejected. The majority of rejections were because disablement was not found to be the result of vaccination, but some claims were not investigated because disability was not deemed sufficiently severe, and in a small number of cases vaccine damage was accepted by the tribunal, but the claim failed because of the 80 per cent. rule.
There are four main problems causing widespread concern. The first is the adequacy of compensation. It has long been held by the Association of Parents of Vaccine Damaged Children—I pay tribute to that organization which helped me prepare tonight's debate for its concern over a number of years—that, because of widespread concern in Parliament at the time of the passage of the Act, the provisions of the Act would be interim. Much of that worry stems from the inadequacy of the capital figure.
The sum now available to be awarded—£20,000—is woefully small compared to the sums awarded by courts to victims of medical accidents. The awards to young people in exactly the same circumstances as my constituent Bernice are now reaching hundreds of thousands of pounds. The difference that that makes in terms of provision for a child is obvious. Not only are there capital needs to be satisfied, perhaps related to the physical needs of disablement such as changes in the construction of a house and the provision of security for children such as Bernice who are prone to fall regularly due to fits, but money also has to be found for holiday care, and sometimes to compensate for wage loss of parents devoting their lives to the care of a child.
The future also has to be considered. Bernice's father wrote:
I am 67 years of age and my wife is 52 and our biggest concern is what will happen to her when we are gone, whilst if we were able to set up a trust fund for her welfare, it would lessen our fears.
There is no financial comparison between Bernice's position and that of a child left damaged by any other medical accident. We are therefore a world away from the Pearson commission's desire to see all treated equally, regardless of the cause of disability.
I do not wish to promote the cause of no-fault compensation. I merely ask my hon. Friend the Minister to bear in mind the huge disparity which has grown in recent years because of the size of awards being made in the courts and to ask whether the size of that disparity can be reduced.
Secondly, will the Minister review the 80 per cent. rule? As I have said, there have been cases where damage has been assessed by the tribunal to be caused by the vaccine, but no award has been made because the level of disability is less than 80 per cent. Surely it cannot be beyond our wit to devise a sliding scale of payments to compensate youngsters for the degree of disability they suffer. It is time for us to consider seriously, and to end, that anomaly.
Thirdly, some parents, dissatisfied with the scheme, have tried to take legal action to prove negligence. We


know that success in the courts in negligence cases opens the way to massive awards. The difficulties, however, of piloting such a route to adequate compensation have been well documented over the past 20 years. The cases of Kinnear, and particularly Loveday, stand out.
The Loveday case failed when a judge said that, on the balance of probabilities, the plaintiff's case did not satisfy him that whooping cough vaccine could cause permanent brain damage in young children. He said:
It is possible that it does; the contrary cannot be proved.
Until March of this year, that judgment stood in the way of progress in cases of negligence because legal aid was being ruled out in similar cases and preventing them from getting under way. Now a judge has ruled that that case is no bar, and the way is open again for more claims. But to what end—more cost, heartbreak and time lost? Could we not end this struggle towards proving negligence with a more open and generous compensation system?
Will the Minister consider immunisation for all potential diseases, not just whooping cough? I am a firm supporter of immunisation. My father is a general practitioner and I welcome the success that has been achieved over the centuries since immunisation became widespread and the effect that it has had on preventive medicine in this country.
I support whooping cough vaccination. The right hon. Member for Stoke-on-Trent, South (Mr. Ashley), to whom I pay tribute for his exceptional work on this subject and who was kind enough to drop me a note earlier today supporting this debate, extracted an answer from my hon. Friend the Member for Derbyshire, South (Mrs. Currie)in 1987, when he was given the figures for deaths resulting from whooping cough in recent years. During the period 1957–61, there were 200 deaths from whooping cough in this country; by 1982–86, the number had fallen to 29. It should never be forgotten that in years gone by whooping cough was a killer, and I am glad that those days are largely gone.
In my constituency, the notified cases of whooping cough in 1988 had fallen to as low as 13. Vaccination figures are high in my constituency and I pay tribute to my health authority for the hard work it does in ensuring such a high rate of immunisation. Also, the view of the director of public health in Bury, Dr. Christopher Hallett, is:
My colleagues and I are now quite confident about recommending the whooping cough vaccine and anxious to protect as many vulnerable children as possible. With all the publicity about the so called side effects of whooping cough vaccine I cannot believe that there are any hidden cases of alleged vaccine damage in the community about which no one has informed me.
To his knowledge, there were only two cases in Bury of children damaged by whooping cough vaccine.
All that goes to prove the efficacy of immunisation and the fact that tragedies resulting from things going wrong are few. My personal experience and support for vaccination was shown when my children were immunised. My little girl, Hazel, was immunised first and reacted badly to her first injection, so we stopped the second injection. We had no hesitation in having our little boy immunised, despite Hazel's reaction. He successfully completed both injections and is now immunised. Therefore, I believe firmly in immunisation.
However, if we are to proceed with the programme and encourage more people towards it, a better security system should be found for those for whom something might go wrong. We are extending the targets.
In passing, I would say that, where doctors have contacted parents and they have refused vaccination for their children, they should be made to sign a form saying that the matter has been fully explained to them but that they have nevertheless refused to have their child vaccinated. That would assist parents to realise what a serious step they were taking in not allowing their child to be vaccinated. Each case should then be included in the doctor's quota towards his target.
If we are to extend immunisation to as many people as possible, some protection for parents who fear that something might go wrong would be welcome. That is why I wish to see a change in the system.
My solutions to the problems that I have illustrated are briefly these. We should discuss the possibility of a larger capital award. The disparity between the figures shows that a larger capital award is called for. Some parents of vaccine-damaged children argue for rather greater income payments when the child is small, preferring to build up their own capital sum in that way. I hope that my hon. Friend the Minister will consider that.
In addition, it may be worth asking drug companies to support a fund in some way. They gain many benefits from the immunisation programme. Their profits are large, although they are needed for research and development, and I do not criticise them for that. But they have funds that could be made available for a fund for the protection of vaccine-damaged children.
In essence, I would like the Minister to say tonight that he will review the area, that he agrees that problems exist and that he will look at them.
The closing words of my constituent's letter tell us much. He says:
We are not asking for charity. What has happened to Bernice is the sole responsibility of the Government. If we had not been persuaded to have the vaccination, Bernice would have remained a normal, happy and healthy child. As it is she has had no past and very little future without help 24 hours per day.
There is not one hon. Member with happy, healthy, normal children who does not feel for any constituent who finds himself in the situation of Bernice's parents. Such cases are always sad.
I accept that the Government can only do so much, but in this case the concern about the adequacy of compensation and cover for vaccine-damaged children has been widespread for a number of years. The time has come to look again at the matter, and I hope that my hon. Friend will respond to the matters that I have outlined tonight by announcing some form of review.

Mr. Ken Hargreaves: rose—

Mr. Anthony Coombs: rose—

Mr. Deputy Speaker (Mr. Harold Walker): I take it that the hon. Members have the consent of the hon. Member for Bury, North (Mr. Burt) and the Minister to take part in the debate.

Mr. Hargreaves: I congratulate my hon. Friend the Member for Bury, North (Mr. Burt) on initiating this important debate and thank him for the opportunity to contribute briefly to it. I wish to comment on immunisation.
I welcome the steady increase in immunisation in the past few years, which has led to a marked decrease in the number of cases of childhood diseases which can cause deaths and more serious permanent injury. I welcome, too, the Government's efforts to increase the level of immunisation still further, but I share the concern expressed by my hon. Friend about the target system being too rigid and I fear that that could well result in fewer children being immunised than would otherwise be the case.
In some areas of my constituency, for example, doctors will achieve 90 per cent. with comparative ease. In other areas, despite possibly working harder and making greater efforts, they will achieve 75 per cent. because of the different type of people living in their area. In those circumstances, only the dedication and professionalism of the doctor will ensure that he works to immunise as many children as possible, knowing that he will not achieve his target. It is therefore essential that the effectiveness of targets is clearly monitored to ensure that they are set at realistic levels so that the Government's aims can be achieved. I hope that my hon. Friend the Minister will also give my hon. Friend the other assurances that he has sought.

Mr. Anthony Coombs: I, too, thank my hon. Friend the Member for Bury, North (Mr. Burt) for the chance to contribute to this important debate. My interest in the subject was aroused by the case of Sally Anne Mills, a four-year-old girl from my constituency who contracted poliomyelitis as a result of vaccination, and who was recently told by a vaccine damage tribunal that she was only 60 per cent. disabled. The tribunal said that there was some measure of comparability between Sally's problems and conditions 26 and 27 in the Social Security Regulations 1982—amputationsbelow the knee, which constitute no more than 60 per cent. disability.
Despite that equivalence, my constituent will receive no compensation or payment. It seems ridiculous not to grade payments according to disability or to give a lump sum payment on the basis of 80 per cent. Even if one accepts, as Lord Henley, a Social Security Minister told me, that these payments are not compensation but social security payments, it is wrong that someone with an 80 per cent. disability should get £20,000 for future requirements as a result of disability, while someone with a 60 per cent. disability receives nothing.
There is a strong case for making these payments by way of compensation. If the Government are—rightly—encouraging people to take up vaccination, and if it then goes wrong through no fault of the recipient, flexible compensation should be paid.
Lord Henley suggested to me that legal action on the grounds of negligence could lead to payments for people affected in this way. The Law Society tells me that no person affected by poliomyelitis has ever successfully prosecuted a case in the courts. There is often no

negligence to prove, since doctors have acted perfectly reasonably and respectably—yet an unforeseeable accident has taken place.
If there are as few cases of medical accidents for which compensation should be paid as my hon. Friend the Member for Bury, North has suggested, it would not cost the Government much to pay out the compensation forthwith, and on a far more generous scale.

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell): I congratulate my hon. Friend the Member for Bury, North (Mr. Burt) on raising this important subject, and I offer my sympathy to my hon. Friends the Members for Hyndburn (Mr. Hargreaves) and for Wyre Forest (Mr. Coombs) for the cases that they described.
Any child involved in vaccine damage represents a real human tragedy. There can be no circumstances more poignant than those of a child which is thought, rightly or wrongly, to have been damaged by a vaccine intended to give it protection against disease and not to subject it to a life-disabling condition. We have to try to deal with such cases as sympathetically as we can.
We must also set the issue in context and remember that the overwhelming result of the immunisation programme has been an enhancement of public health. The programme has been a phenomenal public health success that we should do nothing to inhibit or upset.
The World Health Organisation has set a target of 90 per cent. for children to be immunised against a raft of diseases, and that target is built into the GPs' contract, as my hon. Friend the Member for Hyndburn stressed.
I should like in passing to explain why the Government disagree with the approach outlined by my hon. Friend the Member for Hyndburn, who suggested that we should discount those who refuse immunisation. It is our objective, on public health grounds, to achieve a minimum of 90 per cent. immunisation. If that target is not achieved, for whatever reason, policy makers and NHS managers will have to deal with the shortfall. We should not seek to rig the targets so as to convince ourselves that we are achieving an objective when in fact we are not.
We all welcome the fact that as of February the immunisation programme against polio, diptheria and tetanus is now achieving an 88 per cent. take-up rate. The take-up rate for measles, mumps and rubella immunisation is 85 per cent., while the take-up rate for whooping cough is 80 per cent. That is not just the achievement of some target set by the World Health Organisation—there has been a definable improvement in public health standards which can be directly attributed to that immunisation programme.
The incidence of whooping cough has been dramatically reduced as a result of that programme. The incidence of measles is now at its lowest ever level and, with the exception of a couple of isolated cases, one of which was instanced by my hon. Friend the Member for Wyre Forest, polio is now virtually extinct. On a personal note, that means a great deal to me because one of my aunts, who was also my godmother, was disabled by polio at the age of three and throughout her life suffered from the disability that polio causes. In a relatively short time, a


disease of which parents of young children used to live in fear has been eliminated. That is a substantial advance which we should do nothing to undermine.
Despite the undoubted public health benefits that the immunisation programme has made possible, there remains a fluctuating but continuing concern about the safety of the vaccines. Most strikingly, that concern welled up during the 1970s in connection with whooping cough vaccine. The figures are striking. In 1950 there were about 100,000 cases of whooping cough. By 1973, when there was 80 per cent. acceptance of whooping cough vaccine, the incidence of the disease had fallen to about 2,400 cases per annum. There was then a scare, acceptance of the vaccine fell from 80 to 30 per cent., and the incidence of the disease rose from 2,400 cases per year back to the 100,000 per year level that occurred in the early 1950s. There was thus a dramatic slide in what had been a public health success. I am pleased to say that that success is again with us.
Against that background, the Government of the day introduced the Vaccine Damage Payments Act 1979, on which my hon. Friends have concentrated in their speeches. As my hon. Friend the Member for Bury, North made clear, that Act introduced a payment—originally of £10,000—to relieve the suffering caused by vaccination damage to a child early in life. That payment is made where a child suffers 80 per cent. disability, where the disability can be said to have been caused by a vaccine on the limited list defined in the Act.
The Act was intended to help relieve the suffering caused to families in which such tragedies occurred, but it also sought to rebuild confidence in the immunisation programme and to encourage vaccination rates to rise again. That is important, because we are now back to the levels of between 80 and 90 per cent. acceptance of the immunisation programme.
It is important to understand that the payments made under the Vaccine Damage Payments Act are not intended

to be compensation in the sense that compensation is awarded if a successful claim for negligence is brought against a contractor. Payments made under the Act do not affect the individual's right to compensation if negligence can be proved. They are in the nature of ad hoc payments and are not intended to be compensation of the kind that would be awarded by a court if fault were proved.
That important distinction of principle should not be lost. That is why I do not accept the direct comparison which my hon. Friend the Member for Bury, North sought to draw between the level of payment under the Act and the level of payment awarded by the courts where negligence has been proved. In a successful negligence action, it seems entirely legitimate that the person whose negligence caused suffering should be required to make a substantial payment which seeks to put the injured party, as far as that is possible financially, in the position that he would have occupied if the negligence had not occurred. That has never been the aim of payments made under the Act.
My hon. Friend the Member for Bury, North said that he did not wish to reopen the principle of no-fault compensation. He then quoted the ambition of the Pearson committee—that we should seek to ensure that no injured child was in a better position than another injured child as a result of distinctions in compensation. Although that sounds an attractive ambition, it is not achievable because we cannot deal with a child who is disabled by illness. It is an approach which does not overcome the fundamental problem of causation. That has been emphasised by the Loveday judgment and the decisions which have flowed from it.
The technical details of the Vaccine Damage Payments Act 1979 are matters for the Department of Social Security, and I shall draw—

The motion having been made after Ten o'clock and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-four minutes to Two o'clock.